Hydronephrosis in the early stage of pregnancy after renal transplantation

A 28-year-old woman with end-stage renal disease due to congenital hypoplasia and vesicoureteric reflux in the bilateral kidneys received a renal transplant from her 52-year-old mother. She became pregnant 3 years later. The serum creatinine level was 1.6 mg/dL with a creatinine clearance of 27.3 mL/min/1.48 m(2) just prior to pregnancy. Her graft showed hydronephrosis at 12 weeks of pregnancy. At 25 weeks a double J-type stent catheter was placed, without exposure to radiation, because of progressive deterioration of the graft hydronephrosis. Hydronephrosis partially improved, but her serum creatinine level further increased to 2.3 mg/dL. She delivered a healthy boy by routine caesarean section at 34 weeks of pregnancy. Computed tomography demonstrated the ureter wedged between the gravid uterus and the graft. The catheter was removed 10 days postpartum. Six months later, ultrasonographic study did not show hydronephrosis and the serum creatinine level was 2.0 mg/dL.     

Analysis of urgent colonoscopy for acute lower intestinal bleeding

Background: Urgent colonoscopy is often performed to diagnose and stop acute lower intestinal bleeding, but its usefulness has yet to be clarified. The aim of this study was to clarify the present role of urgent colonoscopy for this purpose. Methods Urgent colonoscopy was defined as colonoscopy performed within 48 h of the occurrence of hematochezia. All patients investigated by urgent colonoscopy from September 1996 to March 2000 who were hospitalized in Shimane Medical University Hospital or Shimane Prefectural Central Hospital, Japan, were enrolled in this study. The endoscopic data and medical records of all the investigated patients were reviewed retrospectively to clarify the role of urgent colonoscopy for diagnosing and treating patients with hematochezia. Results A total of 152 patients were enrolled and 137 (90.1%) were successfully diagnosed endoscopically. Ischemic colitis was the most frequent disease found (32.9%), followed by postpolypectomy hemorrhage (9.2%), hemorrhoids (8.6%) and rectal ulcer (7.2%). Endoscopic hemostasis was employed to treat postpolypectomy hemorrhage and bleeding rectal ulcers with favorable results. Conclusions Urgent colonoscopy is useful for the diagnosis of hematochezia. Endoscopic hemostasis is frequently required to treat postpolypectomy hemorrhage and bleeding rectal ulcers.     

Sleep disturbances as a predictor of occupational injuries among public sector workers

The association between disturbed sleep and increased risk of occupational injury has been observed in several cross-sectional and case–control studies, but prospective evidence is lacking. We examined prospectively whether sleep disturbances predicted occupational injuries in a large population of Finnish public sector employees. A total of 48 598 employees working in 10 municipalities and 21 hospitals in various parts of Finland were included. Sleep disturbances were assessed with the four-item Jenkins Sleep Problems Scale. Records of sickness absence due to occupational injury during the year following the survey were obtained from employers' registers. A proportion (9076; 22%) of participants reported disturbed sleep, and 978 (2.4%) had a recorded occupational injury. After adjustment for socio-demographic characteristics, the odds ratio (OR) for occupational injury was 1.38 [95% confidence interval (CI) 1.02–1.87] times higher for men with experiences of disturbed sleep than for those without sleep disturbances, but not significant for women. Of the sub-dimensions of sleep disturbances, the OR for occupational injury was 1.69 (95% CI 1.26–2.26) for women with difficulties initiating sleep, but not significant for men. These associations remained after additional adjustment for work stress, sleep length, obesity, alcohol use and mental health. This study suggests that sleep disturbances are a significant predictor of occupational injuries even after accounting for a range of covariates.     

Prospective study of nesidioblastosis in newborns and infants: Hypoglycemic seizures,epileptogenesis and the significance of the C-peptide suppression test in pancreatectomy

The long-term follow-up of chronic hyperinsulinemic seizures, epileptogenesis and other neurological complications in five patients who were treated with conservative therapy followed by pancreatectomy during the neonatal period and infancy, who were confirmed to have diffuse nesidioblastosis are described. The reaction pattern of the C-peptide (CPR) suppression test and its relation to the final extent of pancreatectomy was examined in four patients. The chronological change in electro-encephalography (EEG) and its epileptogenesis was also examined in each patient during hyperinsulinemic hypoglycemia, and during normoglycemia in a long-term post-pancreatectomy follow-up. All patients demonstrated several types of hypoglycemic seizures, ranging from apnea, erratic seizures, partial seizures evolving to generalized/unilateral tonic-clonic or tonic seizures, myoclonic seizures and EEG abnormalities. Four of five patients still suffered from epilepsy at the age of 4–22 years. The reaction pattern of the CPR suppression test showed dichotomy, with a hyper-reactive pattern in two patients who required total pancreatectomy to control hypoglycemia, and a suppression pattern in two other patients treated with 90–95% pancreatectomy. Neonatal onset and subsequent myoclonic seizures were ominous signs of epileptogenesis to various types of intractable epilepsy and other neurological sequelae. A prompt diagnosis and pancreatectomy of a sufficient extent at the first operation are essential. The CPR suppression test may be useful for a prompt diagnosis and selection of the extent of pancreatectomy.     

Early Afterdepolarization Abolished by Potassium Channel Opener in a Patient with Idiopathic Long QT Syndrome

Abolished Early Afterdepolarization by Nicorandil. We describe a 17-year-old boy with idiopathic long QT syndrome and repeated syncopal episodes. Early afterdepolarization (EAD) in the monophasic action potential (MAP) was demonstrated in the posterior septum of the left ventricle. Injection of the potassium channel opener nicorandil decreased KAD and shortened MAP duration. The syncopal episodes due to ventricular fibrillation disappeared after administration of the potassium channel opener.     

Electron microscopic stereological study of collagen fibrils in bovine articular cartilage: volume and surface densities are best obtained indirectly (from length densities and diameters) using isotropic uniform random sampling

Results obtained by the indirect zonal isotropic uniform random (IUR) estimation were compared with those obtained by the direct point and interception counting methods on vertical (VS) or IUR sections in a stereological study of bovine articular cartilage collagen fibrils at the ultrastructural level. Besides comparisons between the direct and indirect estimations (direct IUR vs indirect IUR estimations) and between different sampling methods (VS vs IUR sampling), simultaneous comparison of the 2 issues took place (direct VS vs indirect IUR estimation). Using the direct VS method, articular cartilage superficial zone collagen volume fraction (V_v 41%) was 67% and fibril surface density (S_v 0.030 nm²/nm³) 15% higher (P<0.05) than values obtained by the indirect IUR method (V_v 25% and S_v 0.026 nm²/nm³). The same was observed when the direct IUR method was used: collagen volume fraction (V_v 40%) was 63% and fibril surface density (S_v 0.032 nm²/nm³) 21% higher (P<0.05) than those obtained by the indirect IUR technique. Similarly, in the deep zone of articular cartilage direct VS and direct IUR methods gave 50 and 55% higher (P<0.05) collagen fibril volume fractions (V_v 43 and 44% vs 29%) and the direct IUR method 25% higher (P<0.05) fibril surface density values (S_v 0.025 vs 0.020 nm²/nm³) than the indirect IUR estimation. On theoretical grounds, scrutiny calculations, as well as earlier reports, it is concluded that the direct VS and direct IUR methods systematically overestimated the V_v and S_v of collagen fibrils. This bias was due to the overprojection which derives from the high section thickness in relation to collagen fibril diameter. On the other hand, factors that during estimation tend to underestimate V_v and S_v, such as profile overlapping and truncation (‘fuzzy’ profiles), seemed to cause less bias. As length density (L_v) and collagen fibril diameter are minimally biased by the high relative section thickness, the indirect IUR method, based on utilisation of these estimates, is here regarded as representing a ‘gold standard’. The sensitivity of these 3 methods was also tested with cartilage from an in vitro loading experiment which caused tissue compression. In the superficial zone of articular cartilage V_v and S_v of collagen fibrils increased (P<0.05). This difference in the stereological estimates was only detected by the indirect IUR estimation but not by the direct VS or direct IUR methods. This indicated that the indirect IUR estimation was more sensitive than the direct VS or direct IUR estimations. On the basis of these observations, the indirect zonal IUR estimation can be regarded as the technique of choice in the electron microscopic stereology of cartilage collagen.     

Differences in arousal response between aged and middle-aged patients with obstructive sleep apnea syndrome

Abstract The aim of this study is to show the clinical significance of the differences in arousal response at a termination of apnea/hypopnea between aged and middle-aged patients with obstructive sleep apnea syndrome (OSAS). We polygraphically assessed electrocardiographic (ECG) and electroencephalographic (EEG) arousal. Electrocardiographic arousal was defined as an abrupt increase in heart rate at a termination of apnea/hypopnea. Our findings showed that EEG and ECG arousal at a termination of apnea/hypopnea were significantly suppressed in aged patients with OSAS, which might provide useful information on the pathophysiology of OSAS.