Successful surgical management of complete tracheal disruption due to penetrating injury

Successful management of penetrating injury to the trachea is rare, especially in Japan. A 32-year-old female attempted suicide by stabbing herself in the throat with a knife, and at operation the trachea was found to be completely disrupted. A median sternotomy made possible end-to-end anastomosis of the trachea. All other important organs including the great vessels, esophagus, and lungs were intact, but the pleura was open on the right side. The patient was managed under heavy sedation and with controlled ventilation for more than a week postoperatively, because of her suspected mental condition. She was extubated on postoperative day 13 and transferred to a mental hospital on day 16. We concluded that early diagnosis and surgical repair were important for the successful management of this patient with tracheal disruption.     

Malignant pheochromocytoma of the urinary bladder: Effectiveness of radiotherapy in conjunction with chemotherapy

A 34-year-old Japanese man with malignant pheochromocytoma of the bladder underwent surgical resection and chemoradiotherapy for a local recurrence of lymph node metastasis. Radiotherapy seemed to be effective, indicated by the growth inhibition of the irradiated tumor, decreases in serum and urinary catecholamine levels and a clinical improvement in the refractory stage of the combined chemotherapy.     

Rapidly progressive aphasic dementia and motor neuron disease

Articulatory and language impairment heralded rapidly progressive motor neuron disease in 7 patients aged 54 to 77 years. One patient had a family history of a similar disorder. Severe nonfluent aphasia developed in all 7 patients and 4 were anarthric within a year. Other cognitive domains were impaired, yet 2 patients lived alone until 1 month before their deaths. Four died within 2 years. Abnormalities were found on electromyography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and electroencephalography. Neuropathological examination in 3 patients showed bilateral hemispheric atrophy with neuronal loss and gliosis predominantly of superficial cortical layers. Pigmented and hypoglossal nuclei were relatively preserved. At all spinal levels there was degeneration of corticospinal tracts and loss of anterior horn cells with gliosis. Rapidly progressive aphasic dementia and motor neuron disease are a distinctive clinical entity whose nosology is poorly understood.     

Relationship between Aortic-to-radial Arterial Pressure Gradient after Cardiopulmonary Bypass and Changes in Arterial Elasticity

Background: An aortic-to-radial arterial pressure gradient may develop during and after cardiopulmonary bypass (CPB). The mechanisms of this pressure gradient remain controversial. To clarify the cause of the pressure gradient after CPB, the authors investigated the relationship between the pressure gradient and changes in the pulse wave velocity (PWV) before and after CPB.

Methods: The pressure gradient from the aorta to the radial artery and a change in PWV were measured with a wire (0.37 mm in diameter) tipped with a miniature pressure transducer in 12 patients undergoing cardiac surgery. The pressure distributions and waveforms were measured and recorded with electrocardiograph. The PWV was calculated by measuring the propagation time between the R wave of the electrocardiograph and the rising point of the arterial pressure waveform at 10-cm intervals.

Results: After CPB, 7 of 12 patients demonstrated a marked pressure gradient. In these patients, the pressure distribution showed a gradual decrease toward the periphery without a precipitous step-down in pressure at any one specific anatomic location. The PWV decreased as the intraarterial pressure decreased from the aorta to the radial artery, and the relative arterial elasticity decreased linearly toward the periphery.     

Detection and identification of oxalate-degrading bacteria in human feces.

BACKGROUND: Oxalate is detoxified (catabolized) via the action of two enzymatic proteins, formyl coenzyme A transferase (encoded by the frc gene) and oxalyl coenzyme A decarboxylase (encoded by the oxc gene), contained in the cytosol of Oxalobacter formigenes that colonizes the human intestinal tract. It is speculated that oxalate-degrading bacteria decrease oxalate absorption from the intestines and their absence in the gastrointestinal tract correlates with the formation of calcium-oxalate urolithiasis. METHODS: Two methods of detection and identification of this bacterial strain were studied in human fecal samples collected from Japanese subjects. Genomic DNA was isolated from bacterial culture, and specific 16S rDNA was amplified by polymerase chain reaction (PCR) followed by sequencing. The oxc gene was amplified directly from human feces by PCR using the specific primers. RESULTS: Oxalate-degrading bacteria were identified by comparing the sequences of 16S rDNA. The oxc gene was directly detected from human feces by PCR. It was ascertained that a combined PCR detection method using both 16S rDNA and the oxc gene allows for identification of O. formigenes in human fecal samples. CONCLUSION: This detection and identification method of oxalate-degrading bacteria using 16S rDNA and oxc gene should be applied in examination of clinical samples.     

EFFECTS OF PINDOLOL ON THE CARDIOVASCULAR RESPONSE TO TRACHEAL INTUBATION

Laryngoscopy and tracheal intubation often cause hypertensionand tachycardia, which may be exaggerated during rapid-sequnceinduction of anaesthesia.We was studied the efficacy pindololin attenuating the cardiiovascular responses to laryngoscopyand intubation in patients receiving pindolol 2 µg kg^–1or 4 µg g^–1 min before induction of anaesthesiain a double-blind design. The data were compared with thosefor a control group receiving saline. Each group consisted of10 patients undergoing elective surgery. Anaesthesia was inducedwith thiopentone 5 mg kg^–1 i.v. and trachea/intubationwas facilitated with vecuronium 0.2mg kg^–1 Patients receivingsaline showed a significant increase in mean arterial pressureand heart rate associated with tracheal intubation. These increasesafter tracheal intubation were reduced in pindolol 4 4 4 µgkg^–-1 treated patients compared with those of the controlgroup (P<0.05). Pindolol 2 µg kg^–1 attenuatedtachycardia in response to intubation but did not afftect hypertension.These data suggest that a bolus injection of pindololµg4 kg^–-1 is a simple, practical and effective method foratenuating cardiovascular responses to laryngoscopy and trachealintubation.     

Manipulo-spatial processing of ideographic characters in left-handers: observation in fMRI.

It has been suggested that left-handers have a cerebral ambilaterality for language representation. Specifically, the use of the right hand for writing may have a specific effect on the cerebral organization in left-handers. In an investigation of the relationship between motor and visual language procedures, functional magnetic resonance imaging at three tesla was conducted during stroke counting of kanji (Japanese ideographic characters) in six left-handers who usually write with their right hand. Two types of stimulus presentation, phonography-displayed and kanji-displayed, were employed to examine the different neural pathways used for processing kanji. Each stimulus presentation involved two motor conditions: one allowed finger movements for tracing the characters, while the other disallowed finger movements. The tasks induced activation in the primary motor area, the premotor area, the supplementary motor area, and the anterior cingulate gyrus as well as the parietal and occipital lobes (Brodmann's area 7/39/19). The activated areas in both the movement-allowed and movement-disallowed conditions were almost identical except for the primary motor area. These results clearly contrasted with those of a previous study of right-handers which showed that right-handed volunteers demonstrated decreased activation in the premotor area and the dorsal pathway during the movement-allowed condition. This discrepancy may be attributable to a difference in cerebral organization for language processing. Specifically, in left-handers, the visuospatial procedure for kanji and the motor procedure for tracing the kanji may be ambilaterally distributed in both hemispheres, whereas in right-handers these procedures may be predominantly lateralized in the left hemisphere.