Pneumocephalus caused by failed ventricular tap: case report

OBJECTIVE AND IMPORTANCE: Ventricular tap is one of the most basic and important techniques to neurosurgeon. Brain tap itself usually does not cause symptomatic complication. The authors report an extremely rare complication case of pneumocephalus caused by failed ventricular tap. CLINICAL PRESENTATION AND INTERVENTION: A 79-year-old woman suffered from normal pressure hydrocephalus after subarachnoid hemorrhage (SAH). Ventriculo-peritoneal shunt was performed two month after SAH. In the operation, ventricular taps were failed twice and third tap was successful for ventricular catheterization through the right posterior parietal burr hole. She presented left hemiparesis from three hours after the operation, and her symptom was gradually deteriorated to complete paralysis the next day. Computed tomography scan disclosed the movement of air along the tract of failed ventricular tap from subcortex to internal capsule. CONCLUSION: Failed ventricular tap could cause severe complications. We have to try to perform ventricular tap by only one attempt.     

A case of ruptured true posterior communicating artery aneurysm with neurogenic pulmonary edema treated early by GDC embolization

A case of ruptured true posterior communicating artery aneurysm with neurogenic pulmonary edema is presented. A 31-year-old male suffered the sudden onset of unconsciousness with respiratory dysfunction and pinkish foamy sputum. Computed tomography demonstrated diffuse subarachnoid hemorrhage and chest roentgenogram disclosed pulmonary edema. An emergency cerebral angiogram under controlled ventilation revealed that an aneurysm had arisen from the right posterior communicating artery itself. Subsequently GDC embolization and lumbar drainage were performed on day 0. The patient showed full recovery from pulmonary edema on day 6. He suffered multiple cerebral infarctions caused by vasospasm but he atlained a full recovery after 7 months. The follow-up angiogram showed complete obliteration of the aneurysm. This case report suggests that endovascular treatment with lumbar drainage is useful for severe aneurysmal SAH complicated with pulmonary edema in the acute stage.     

Current situation of the external quality control survey provided by the Japan Medical Association and its problems

The Japan Medical Association (JMA) has been providing the external quality survey program in clinical laboratory testing for the past 37 years, 2,812 labs participated in 2003, and it has improved overall interlaboratory variations, particularly in enzyme activity examinations. There are many other external quality survey programs provided independently by the other organizations, and the JMA Committee on Quality Control Survey in Clinical Laboratory Testing, in association with JCCLS and the other expert panels, had discussed on the possibility of implementing a new external quality assessment scheme, named NEQAS (National External Quality Assessment Scheme). The current problems on the external quality control survey are discussed.     

Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm

OBJECTIVE: Sonographically guided radiofrequency ablation is usually one of the most effective treatments for hepatocellular carcinoma. However, the localization of the tumor is a major limiting factor in the use of a sonographically guided procedure. In our experience, sonographic examination with artificial pleural effusion has improved the visualization of hepatocellular carcinomas under the diaphragm. We investigated the safety, benefits, and local efficacy of radiofrequency ablation with artificial pleural effusion. SUBJECTS AND METHODS: Twenty-five lesions in 23 patients were treated using radiofrequency ablation with artificial pleural effusion, for which 5% glucose solution was injected into the pleural cavity. RESULTS: Artificial pleural effusion allowed us to visualize the whole tumor on gray-scale sonography in 22 lesions that were not detectable or were poorly visible and to obtain a safer and easier puncture line in 14 lesions. In 23 (92%) of the 25 lesions, artificial pleural effusion was helpful in performing percutaneous radiofrequency ablation. Complete necrosis after radiofrequency ablation was obtained in 22 (88%) of the 25 lesions. During a mean (+/- SD) follow-up period of 10.6 +/- 6.5 months, local recurrence at the ablation site was diagnosed in only one (4.5%) of the 22 lesions. Mild cough in three patients and mild dyspnea in two patients were observed as adverse effects of artificial pleural effusion, but these effects were temporary. Oxygen saturation of the blood during artificial pleural effusion was slightly decreased. CONCLUSION: Radiofrequency ablation with artificial pleural effusion is a safe and beneficial treatment option that offers excellent local control through visualization of hepato-cellular carcinomas under the diaphragm.     

The mechanism of contractile dysfunction in heart failure, focussing on SERCA2a function

Cytosolic Ca(2+) is a key regulator of excitation-contraction coupling in myocardium. Myocardial contractile dysfunction in heart failure is characterized by a decrease in contraction and prolonged relaxation. These alterations are mainly due to changes in 1) intracellular Ca(2+) transients (CaT), 2) Ca(2+) sensitivity of the contractile elements, and/or 3) contractile proteins. It is useful to investigate the relationship between CaT and contraction for understanding of the mechanism of contractile dysfunction in heart failure. There are many reports regarding the alterations in CaT, Ca(2+) sensitivity, and contractile proteins in heart failure. Changes in the activity of the sarcoplasmic Ca(2+) pump protein, SERCA2a, may be involved in the altered contractility in heart failure. We generated cardiac-restricted overexpression of SERCA2a transgenic mice (TG) and non-transgenic littermates (NTG). To investigate the role of SERCA2a activity for ischemic heart, we used acidosis as a model of acute contractile dysfunction. During acidosis and recovery from acidosis, the peaks of CaT and tension in TG were significantly larger than those in NTG. These results suggest that an increase in the activity of SERCA2a could be beneficial to preserve contractility during acidosis and recovery. Thus, a disturbance of the intracellular Ca(2+) homeostasis is one of the key factors for the contractile dysfunction in heart failure.     

Is man able to breathe once a minute for an hour?: the effect of yoga respiration on blood gases

The ventilatory response to hypercapnia and arterial blood gases during ujjai respiration of once per minute for an hour were determined in a professional hatha yogi. The results suggest that lower chemosensitivity to hypercapnia in yoga practitioners may be due to an adaptation to low arterial pH and high PaCO2 for long periods.     

The proMMP-2 activation rate in patients with chronic viral liver disease

BACKGROUND: Crush syndrome has been described as extensive muscle damage, leading to acute renal failure. The aim of this study was to evaluate the possible role of nitric oxide, tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) in crush syndrome. PATIENTS AND METHODS: A total of 17 patients suffering from crush syndrome, 7 patients without crush syndrome and 10 healthy controls were enrolled in the study. Plasma nitrate, TNF-alpha, IL-1 beta levels and biochemical parameters were measured. RESULTS: All patients with crush syndrome demonstrated acute renal failure. Plasma nitrate levels were elevated significantly in the crush syndrome patients compared with patients without crush syndrome (33.5 +/- 20.1 vs. 15.3 +/- 5 micromol/l, p=0.014). There was no significant difference in TNF-alpha and IL-1 beta levels between control and patient groups. CONCLUSION: Increased plasma nitrate levels in the crush syndrome may be related either to the elevated production of NO or the diminished excretion of nitrate or both.