Brain magnetic resonance imaging and motor and intellectual functioning in 86 patients born at term with spastic diplegia

Aim To investigate the association between magnetic resonance imaging (MRI) patterns and motor function, epileptic episodes, and IQ or developmental quotient in patients born at term with spastic diplegia. Method Eighty‐six patients born at term with cerebral palsy (CP) and spastic diplegia (54 males, 32 females; median age 20y, range 7–42y) among 829 patients with CP underwent brain MRI between 1990 and 2008. The MRI and clinical findings were analysed retrospectively. Intellectual disability was classified according to the Enjoji developmental test or the Wechsler Intelligence Scale for Children (3rd edition). Results The median ages at diagnosis of CP, assignment of Gross Motor Function Classification System (GMFCS) level, cognitive assessment, and MRI were 2 years (range 5mo–8y), 6 years (2y 8mo–19y), 6 years (1y 4mo–19y), and 7 years (10mo–30y) respectively. MRI included normal findings (41.9%), periventricular leukomalacia, hypomyelination, and porencephaly/periventricular venous infarction. The frequency of patients in GMFCS levels III to V and intellectual disability did not differ between those with normal and abnormal MRI findings. Patients with normal MRI findings had significantly fewer epileptic episodes than those with abnormal ones (p=0.001). Interpretation Varied MRI findings, as well as the presence of severe motor dysfunction and intellectual disability (despite normal MRI), suggest that patients born at term with spastic diplegia had heterogeneous and unidentified pathophysiology.     

Primary IgA Glomerulonephritis and Schonlein-Henoch Purpura Nephritis: Clinicopathological and Immunohistological Characteristics

A comparative analysis on clinicopathological and immunohistologicalcharacteristics was performed of 205 cases with primary IgAnephritis and 35 with Schönlein-Henoch purpura nephritis(purpura nephritis). Diagnostic criteria for primary IgA nephritiswere set out so that IgA was either the most prominent immunoglobulinor, at least, equal to IgG and/or IgM, if present, irrespectiveof mesangial or peripheral localization. In primary IgA nephritis,one half of the cases were discovered by asymptomatic proteinuria,and one-third presented recurrent upper respiratory tract infectionand gross hematuria, one-fourth abdominal pain and a few casesjoint pain, while purpura nephritis was associated with a significantlyhigher incidence of such systemic symptoms as abdominal andjoint pains, in addition to purpura. Both diseases shared atendency toward conspicuous hematuria in contrast to the modestproteinuria, with normal renal function in three-fourths totwo-thirds. Moreover, four of 35 with purpura nephritis showedpreceding proteinuria and had been regarded as primary IgA nephritisuntil purpura appeared. The glomerular pathology had a commonfeature in that there was frequent occurrence of mesangial proliferativeand focal and segmental lesions. The immunohistology in thetwo diseases was indistinguishable with regard to the glomerularimmunoglobulins and mediators, whether purpura was present orabsent. Thus, we propose a unifying concept that, by analogywith SLE, primary IgA nephritis may be regarded as ‘sinelupo,’ lying on one side of the nosological spectrum withless systemic symptoms, whereas purpura nephritis may occupythe other side with more systemic aspects. Furthermore, we confirmedthe epimembranous granular deposition of IgA in both diseasesas the most characteristic morphological expression of circulatingimmune complexes.     

Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis

A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.     

Cutting Balloon Angioplasty for Ostial Lesions of the Left Anterior Descending Artery

We evaluated the effectiveness of Cutting Balloon angioplasty for ostial lesions of the left anterior descending artery compared with conventional balloon angioplasty. Cutting Balloon angioplasty (n = 7) produced larger acute gain (1.70 ± 0.37 vs 0.48 ± 0.25 mm, P < 0.001) and smaller late loss index (0.54 ± 0.55 vs 1.32 ± 0.81, P < 0.05) than conventional balloon angioplasty (n = 7). As a result, late restenosis was seen in only two patients undergoing Cutting Balloon angioplasty, but in all seven patients undergoing conventional balloon angioplasty. Ostial lesions of the left anterior descending artery may be one of the suitable targets of Cutting Balloon angioplasty . (J Interven Cardiol 2000;13:7–14)     

Impact of aging on penile hemodynamics in men responding normally to prostaglandin injection: A power Doppler study

AIM: Hemodynamic changes with aging in the penile arterial circulation, including the helicine arteries, were evaluated with power Doppler imaging in erectile dysfunction patients with a normal response to prostaglandin injection. METHODS: In 36 patients with erectile dysfunction and no definite vascular risk factors, 72 corpora were examined using power Doppler imaging. Patients were classified by age: younger than 40 years, from 40 to 49, or 50 and older. Hemodynamic variables in the cavernous arteries, helicine arteries and dorsal arteries were measured after intracavernous injection of prostaglandin E1 (20 microg). RESULTS: All cavernous arteries had a maximum peak systolic velocity of greater than 35 cm/s and a minimum end-diastolic velocity of less than 0 cm/s. Mean peak systolic velocity in the cavernous artery differed between groups (P = 0.016), especially between the younger than 40 age group and the 40-49 age group. Peak systolic velocity correlated negatively with age (P = 0.0048). In the helicine arteries and dorsal arteries, peak systolic velocity did not differ between groups and showed no correlation with age. End-diastolic velocity, resistance index and acceleration time did not differ between groups, or correlate with age for any artery. CONCLUSIONS: Hemodynamic change with aging occurs predominantly in the cavernous arteries, where peak systolic velocity decreases. The arterial circulation beyond the cavernous arteries, including the helicine arteries, as well as veno-occlusive mechanisms, may have an important role in maintaining erectile function in aging.     

Analysis of bone mineral density in urolithiasis patients

BACKGROUND: The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary or non-dietary category in patients with urolithiasis. METHODS: The BMI of the L2-L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age-matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS. RESULTS: Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20-39 years old, 40-59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non-dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01). CONCLUSIONS: In case female stone patients with non-dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.     

Permanent Atrial Pacing Lead Implant Route after Fontan Operation

Background: Atrial pacing is indicated for sinus node dysfunction (SND) after Fontan surgery; preferred lead implantation technique is debated. We compare outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population.
Methods: Retrospective review of Fontan patients undergoing atrial lead implant between 1992 and 2007. Demographics, lead performance data, and outcomes were analyzed.
Results: 78 patients had 90 leads implanted: 25 via TV route and 65 via Epi route. Median follow-up was 1.6 years (TV) and 3.6 years (Epi). TV leads were implanted in older patients (23.1 vs 9.3 years, P < 0.001) and at longer intervals after Fontan (15.2 vs 4.9 years, P < 0.001). Pacing indication for most TV leads was SND, while Epi leads were also indicated for atrioventricular block. Acute complication rates were similar (8% TV vs 19% Epi, P = 0.23), but median hospital stay was shorter for TV (2 vs 5 days, P = 0.03). Thrombus was observed in five patients (two in TV; three in Epi), but no thromboembolic events were observed. Mean lead survival was similar (TV 9.9 vs Epi 7.8 years, P = NS). Energy threshold was lower at implant for TV leads (0.9 vs 2.2 μJ, P = 0.049), but similar at follow-up (1.2 vs 2.6 μJ, P = 0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.1 mV, P = NS), but decreased for Epi (3.3 to 2.5 mV, P = 0.02).
Conclusions: Compared to epicardial leads, transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity and equivalent expectation of lead performance and longevity.     

AICAR Preconditioning Prevents Postischemic Leukocyte Rolling and Adhesion: Role of KATP Channels and Heme Oxygenase

Objective: We previously demonstrated that pharmacologic activation of AMP‐activated protein kinase (AMPK) with 5‐aminoimidazole‐4‐carboxamide 1‐β‐D‐ribofuranoside (AICAR) 24 hours prior to (AICAR preconditioning; AICAR‐PC) ischemia/reperfusion (I/R) prevents postischemic leukocyte‐endothelial cell adhesive interactions (LEI) by a mechanism initiated by endothelial nitric oxide synthase (eNOS)‐dependent NO production during the period of AICAR‐PC. The major aim of this study was to examine the role of ATP‐sensitive potassium (K_ATP) channels and heme oxygenase as mediators of the antiadhesive effects of AICAR‐PC during I/R 24 hours later. Methods: Intravital fluorescence microscopy was used to quantify LEI in the small intestine of AICAR‐preconditioned C57BL/6J mice treated with K_ATP channel or heme oxygenase inhibitors during I/R 24 hours after AICAR‐PC in separate experiments. Results: I/R induced marked increases in LEI relative to sham control mice, proadhesive responses that were prevented by AICAR‐PC 24 hours prior to I/R. The effects of AICAR‐PC to prevent postischemic LEI were abolished by K_ATP channel or heme oxygenase inhibition during I/R. Discussion/Conclusion: Our results indicate that the antiadhesive effects of AICAR‐PC are mediated by K_ATP channel‐ and heme oxygenase‐dependent mechanisms during I/R.     

CLINICOPATHOLOGICAL STUDY OF UNSUSPECTED GALLBLADDER CANCER DIAGNOSED AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background: Laparoscopic cholecystectomy (LC) has become a common treatment for benign gallbladder diseases. However, this method has not been established for gallbladder cancer. Methods: In the present study, we examined the clinicopathlogical features of gallbladder cancer that was diagnosed after LC. Results: The presence of unsuspected gallbladder cancer was found in five out of 498 patients (1.00%). Preoperative diagnoses were gallstone in two, gallstone with adenomyomatosis in one, adenomyomatosis in one and gallbladder polyp in one. During LC, there was no evidence of cancer, but bile leakage occurred in two patients. Histologically, the carcinoma had invaded into the subserosa in four patients and into the mucosa in one patient. An additional operation was performed in three patients. Histological examination revealed no cancer cells in the resected liver and lymph nodes. During the average follow‐up period of 47.5 months, no recurrences were observed. Although one patient died of liver metastasis 33 months later, the other three patients who underwent an additional radical operation, showed no recurrence. Conclusions: It is important to prevent port site recurrence or dissemination during LC, so a careful maneuver is required to avoid perforation of the gallbladder. At the time of bile leakage, it is best to wash around the liver bed fully to prevent recurrences of unsuspected gallbladder cancers. If gallbladder cancer has invaded the subserosa or deeper level histologically, a radical second operation should be performed as soon as possible.