Complete heart block resulting from quadricuspid aortic valve penicillin-resistant pneumococcal endocarditis: a case report.

A 62-year-old woman was referred to hospital to be treated for complete heart block with syncope. A quadricuspid aortic valve without vegetation and aortic valve regurgitation (AR) were observed by transesophageal echocardiography. Blood culture showed penicillin-resistant Streptococcus pneumoniae. The patient received a permanent pacemaker implantation (VDD type) and was given antibiotics. Although infection improved, heart failure was not improved because AR hemodynamic changes became worse. An aortic valve replacement was performed using a prosthesis on the 26th day of hospitalization. The patient recovered and was discharged.     

Acute regulation of the epithelial sodium channel gene by vasopressin and hyperosmolality.

The amiloride-sensitive epithelial sodium channel (ENaC) plays a key role in sodium reabsorption in the collecting ducts. We examined ENaC mRNA distribution along the nephron and acute effects of vasopressin and hyperosmolality on ENaC mRNA expression. ENaCalpha, beta, and gamma mRNA expressions were observed in cortical, outer medullary and initial inner medullary collecting ducts (CCD, OMCD and ilMCD, respectively). ENaCalpha mRNA expression was also observed in medullary and cortical thick ascending limbs (MAL and CAL, respectively), while ENaCbeta and gamma mRNA expressions were not observed. Furthermore, ENaCalpha mRNA expression in MAL but not in collecting ducts was stimulated by acute exposure to arginine vasopressin (AVP), 8-(4-chlorophenylthio) (CPT)-cAMP and hyperosmolality. However, the physiological significance of these effects is not known, since ENaC protein is reported to be absent in MAL. These data suggest that ENaCalpha mRNA expression in MAL but not in collecting ducts is acutely regulated by AVP and hyperosmolality. The absence of stimulation of ENaCalpha mRNA expression in collecting ducts suggests the physiological significance of ENaCbeta and gamma mRNA for acute regulation by vasopressin. Determining the physiological significance of the acute effect of vasopressin in MAL will require further investigations.     

Assessments of progression in non-muscle-invasive bladder cancer

We retrospectively studied 463 patients with primary non-muscle-invasive bladder cancer diagnosed between 1999 and 2008 at two facilities (Kawasaki Municipal Ida Hospital and Yokohama Minami Kyosai Hospital). In this study, disease progression was defined as invasion to the muscle or further (upstage) and presence of metastasis (metastasis). We detected progression in 22 cases, including 18 upstages and 4 metastasis. Univariate analysis showed that factors associated with progression were T category (pT1 p< 0.0001), grade (high grade p< 0.0001, G3 p< 0.0001) and number of tumors (multiple p=0.0213). Multivariate analysis showed that the only equivocal factor associated with progression was T category (T1). Use of a second tansurethral resection for high-grade pT1 cases was unrelated to progression. Among the patients with progression, many had a more advanced T category at the time of radical treatment, and the results of treatment were poor. The factors associated with progression of bladder cancer should be investigated in more detail, so that early radical treatment can be initiated in eligible patients.     

Developmental Abnormalities of Dendrites of the Cerebral Cortical Neurons in Mental Retardation*

Abstract This paper of Golgi studies describes abnormal dendritic structure and development assessed by camera lucida representation, quantitation of dendritic spines, and dendritic branch measurement in metabolic and chromosomal diseases with mental retardation, reviewing the literatures of Golgi study. Neuronal lipid storage diseases with progressive mental and motor deterioration show characteristic meganeurites between the soma and origin of the axon, and all dendrites have fewer number of branches, shorter total basal dendritic length and marked reduction of spines. Phenylketonuria and Lesch-Nyhan syndrome also present decreased number of spines. On the other hand, children and adults with Down's syndrome show poor dendritic spine density and dendritic branchings as well as structural irregularity of spines. This poor' development of dendrites suggesting postnatal poor synaptogenesis may be related to mental retardation in children. These postnatal dendritic abnormalities may be based on genetic factors such as diminished number of cortical granular cells and extrinsic factors which include poor perception of external stimuli as noted in sensory deprivation. Thus, dendritic spine abnormalities may be correlated with mental retardation. However, we need better staining method and more sytemic study.     

Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy

BACKGROUND: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography. METHODS: From April 1996 to December 1997, a total of 214 men aged 48-86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value. RESULTS: The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI (r = 0.470; P < 0.0001) and PCAR (r = 0.334; P < 0.0001). Correlations were found between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS) (r = 0.389; P < 0.0001), peak flow rate of uroflowmetry (r = -0.393; P < 0.0001). CONCLUSION: We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.     

Changes in Brain Thyrotropin-Releasing Hormone (TRH) of El Mice

The present study showed that DN-1417 had a dose-dependent anticonvulsant activity on El mouse seizure. This finding is consistent with other reports using the kindling model of epilepsy. Since both the El mouse and kindling preparations have been regarded as complex partial seizure with secondary generalization, endogenous brain TRH, as well as exogenous TRH, may act as an anticonvulsant substance to such a seizure type of epilepsy. Moreover, this study showed IR-TRH of the El mouse changed significantly in the striatum or hippocampus genetically or postictally without a change in the TRH receptor binding. A transient decrease in hippocampal IR-TRH after convulsion shown in this study may suggest an increased release of TRH during and after the seizure.
Further studies are required to clarify the relationship between a change in the brain TRH system and seizure susceptibility in the El mouse.     

Significance of plasma glutathione determination in patients with alcoholic and non-alcoholic liver disease

Plasma glutathione levels were determined in 79 patients with various types of liver disease and 18 healthy controls in order to study their significance in the course of liver disease. Plasma was taken at the time of needle liver biopsy. A positive linear correlation was found between plasma and hepatic glutathione concentrations, as has been suggested in experimental animals. In patients with acute viral hepatitis, chronic hepatitis, non-alcoholic liver cirrhosis and alcoholic liver disease, plasma glutathione levels were significantly decreased compared with those in controls. Of importance is the fact that the plasma levels increased after recovery in patients with acute viral hepatitis and after abstinence from alcohol intake in patients with alcoholic liver disease. Determination of plasma glutathione may be valuable in the evaluation of liver disease, particularly in acute viral hepatitis and alcoholic liver disease in which the hepatic content of glutathione is suggested to be decreased. Such patients may be susceptible to oxidative stress and radical-related hepatic injury.