Systemic hypersensitivity vasculitis associated with bronchiectasis.

Systemic hypersensitivity vasculitis developed in a 53-year-old man during acute exacerbation of bronchiectasis infected with Pseudomonas aeruginosa. High grade fever, mononeuropathy multiplex, cutaneous vasculitis, and biopsy specimen-proved mesangioproliferative glomerulonephritis with crescent formation and leukocytoclastic vasculitis associated with circulating immune complex occurred. Corticosteroid and cyclophosphamide therapy was effective for vasculitis and bronchiectasis.     

The effect of body respirator on the desaturation during the night in Duchenne muscular dystrophy

Recently body respirator (BR) has been used to control respiratory failure in patients with late stage Duchenne muscular dystrophy (DMD). We examined the effect of BR using a pulse oximeter. Arterial oxygen saturation (SaO2) for the night (21:00-7:00) was monitored in 15 DMD patients (5 cases without BR, 3 cases with BR partially for the night and 6 cases with BR all night long) and the desaturation (SaO2 less than 90%) time was followed three times (Jan. '87, Nov. '87, Apr. '88) in each patient. Desaturation time did not increase in 4 cases without BR. But in one case without BR it increased so much that we decided to put the patient on BR. In 3 cases with BR partially for the night, desaturation was well controlled when they used BR. No marked increase of desaturation was found in 4 cases with BR all night long. 2 of these cases were changed from cuirass type BR to jacket type BR and were getting on satisfactorily. Thoracic cage expansion of jacket type was larger than that of cuirass type, and it was found that jacket type was valuable. Also, we investigated the cause of desaturation by recording SaO2, nasal flow, thoracic cage motion and abdominal motion at the same time by making use of a polygraphy. The result showed that the main cause of desaturation was the resistance of thoracic cage motion against BR. And we think research and development is needed.     

Life-saving treatment by fluid resuscitation and a thoracotomy in a case of deep pulmonary laceration

CASE: A 41-year-old man survived deep pulmonary and hepatic lacerations by treatment with fluid resuscitation, blood transfusion, thoracotomy, and transcatheter hepatic artery embolization. The patient was transferred to our hospital 46 minutes after his motorbike struck a station wagon from behind. Hemorrhagic shock with systolic blood pressure of 68 mmHg was observed. He showed nonresponse to 20-minute intravenous infusion of 1,500 mL of lactated Ringer's solution. The initial plain chest radiograph showed mediastinal deviation to the left, radio-opacity of the right lower lobe, and decreased radiolucency of the right thorax. Rapid drainage of 800 mL of blood through a right chest tube led to a diagnosis of a deep pulmonary laceration of the right lower lobe. Abdominal computed tomography revealed another deep laceration affecting 40% of the liver. A right lower lobectomy of the lung was performed at 169 minutes after arrival. After the thoracotomy,transcatheter arterial embolization of the right hepatic artery was performed. The patient was discharged on hospital day 57. CONCLUSION: Prompt diagnosis and appropriate treatment are necessary to save patients with multiple, severe blunt injuries. Advanced Trauma Life Support (ATLS) guidelines should be adhered to for appropriate early treatment of patients with severe trauma.     

Prefrontal activity during flavor difference test: application of functional near-infrared spectroscopy to sensory evaluation studies

Sensory evaluation (SE) of food attributes involves various levels of cognitive functions, yet not much has been studied about its neural basis. Using multi-channel functional near-infrared spectroscopy (fNIRS), we examined the activation of the anterior portion of the lateral prefrontal cortex (LPFC) of 12 healthy volunteers during the SE of tea samples. The experimental task used corresponded to the early phase of the same-different test, and required subjects to attentively taste tea samples and memorize their flavors. To isolate activation associated with the cognitive functions involved in the task, we contrasted the results with those achieved by a control (Ctl) task during which subjects held familiar tea samples in their mouths without actively evaluating their flavor. We probabilistically registered the fNIRS data to the Montreal Neurological Institute standard brain space to examine the results as they correspond with other published neuroimaging studies. We found significant activation in the left LPFC and in the right inferior frontal gyrus. The activation pattern was consistent with earlier studies on encoding of other sensory stimuli, with cortical regions supposed to be involved in semantic and perceptual processing. This research makes a start on characterizing the cognitive process employed during SE from the neuroimaging perspective.     

Safe techniques in surgery for hysteroscopic myomectomy

Hysteroscopic myomectomy is regarded as the best treatment for patients with submucous myomata. However, this procedure has a number of associated complications, including uterine perforation, cervical laceration, hyponatremia and hemorrhage, especially in cases of sessile submucous myomata. To avoid these problems, it is important to make well-advised preparations and manipulations both pre- and intraoperatively. The main surgical considerations for safe hysteroscopic myomectomy are shortening the operating time and avoiding cutting too deeply into the myometrium. With these requirements in mind, a combination of techniques using vaporization and a powerful oxytocic agent, such as prostaglandin F-2alpha, appears to be the safest method of carrying out hysteroresectoscopy for unpedunculated sessile submucous myomata.     

The N-terminus of the Montano virus nucleocapsid protein possesses broadly cross-reactive conformation-dependent epitopes conserved in rodent-borne hantaviruses

The hantavirus nucleocapsid (N) protein is an important immunogen that stimulates a strong and cross-reactive immune response in humans and rodents. A large proportion of the response to N protein has been found to target its N-terminus. However, the exact nature of this bias towards the N-terminus is not yet fully understood. We characterized six monoclonal antibodies (mAbs) against the N protein of Montano virus (MTNV), a Mexican hantavirus. Five of these mAbs recognized eight American hantaviruses and six European and Asian hantaviruses, but not the Soricomorpha-borne Thottapalayam hantavirus. The N protein-reactive binding regions of the five mAbs were mapped to discontinuous epitopes within the N-terminal 13-51 amino acid residues, while a single serotype-specific mAb was mapped to residues 1-25 and 49-75. Our findings suggest that discontinuous epitopes at the N-terminus are conserved, at least in rodent-borne hantaviruses, and that they contribute considerably to N protein cross-reactivity.     

Liquid crystal display screens as stimulators for visually evoked potentials: flash effect due to delay in luminance changes

Purpose

The cathode-ray tube (CRT) screen has recently been replaced by liquid crystal display (LCD) screens as visual stimulators for pattern-reversal visually evoked potentials (p-VEPs). The aim of the study was to evaluate the usefulness of LCD screen to elicit p-VEPs.

Methods

The waveforms of the p-VEPs elicited by a LCD panel were compared with those elicited by a conventional CRT screen. The changes in the luminance of each screen were measured with a photodiode, and the mean luminance change was measured with a luminance meter. VEPs and electroretinograms (ERGs) were also recorded when the monitor was covered by a diffuser.

Results

The p-VEPs elicited by the LCD consisted of the N75 and P100 components of the conventional VEPs and had good reproducibility. The average latency of these components was significantly delayed by 9.8 ms for N75 and 10.2 ms for P100, and the N75-P100 amplitude was significantly larger than the conventional p-VEP elicited by the CRT screen. During the reversal phase, especially from black-to-white, the luminance of the LCD screen was transiently reduced, and it elicited a flash VEP and ERG. A reduction in the contrast of the checks minimized the transient change in the luminance, and the VEP waveform was more similar to that elicited by the CRT screen.

Conclusions

The results suggest that when an LCD monitor is used as an alternative visual stimulator to elicit p-VEPs, the delay in the luminance change and the flash effect needs to be taken into account.