A case of pyogenic liver abscess infected with Fusobacterium necrophorum depicted by microscopy and confirmed by tissue culture

A 40-year-old man was admitted with a continuous high grade fever accompanying a relatively large solitary liver abscess with septations. A puncture of the abscess revealed gram-negative rods that could be identified histologically as Fusobacterium necrophorum, which was later confirmed by tissue culture. The patient was switched to meropenem and penicillin, and cured of the infection. Fusobacterium necrophorum is a rare bacterium causing potentially fatal liver abscesses in humans. Clinicians should bear Fusobacterium necrophorum in mind when treating patients with an enlarged solitary liver abscess.     

Serum chemokine levels are associated with the outcome of pegylated interferon and ribavirin therapy in patients with chronic hepatitis C

Aim: Serum chemokine levels and amino acid substitutions in the interferon‐sensitivity determining region (ISDR) and core region have been associated with treatment outcome of pegylated interferon and ribavirin therapy in genotype 1 hepatitis C virus (HCV)‐infected patients. The present study was conducted to clarify the association between serum chemokines and treatment outcome in patients with chronic HCV‐1 infection in a Japanese cohort. Methods: A total of six serum chemokines were quantified before, during and after pegylated interferon and ribavirin treatment in 79 genotype 1 chronic HCV patients using a multiple bead array system. Viral ISDR and core region variants were determined by direct sequencing. Results: The baseline serum levels of eotaxin, IP‐10 and RANTES were significantly higher in chronic HCV patients than in controls. High levels of eotaxin and macrophage inflammatory protein (MIP)‐1β before therapy and more than two mutations in the ISDR were associated with a sustained virological response, and patients with more than two mutations in the ISDR also had significantly higher MIP‐1β levels. Receiver–operator curve analysis showed a 77% sensitivity and 73% specificity for predicting an SVR using MIP‐1β values. Conclusion: Serum MIP‐1β levels may predict the response to HCV treatment with pegylated interferon and ribavirin and are associated with amino acid substitutions in the ISDR.     

Clinical study of tongue pain: Serum zinc,vitamin B12, folic acid,and copper concentrations,and systemic disease

The aim of this retrospective study of patients with tongue pain who showed no improvement after initial treatment and examination was to find out if their lack of response correlated with serum concentrations of zinc, vitamin B12, folic acid, and copper, and if it was associated with coexisting systemic diseases. We studied 311 patients for whom we had data about serum concentrations of these elements, and recorded whether they had any systemic diseases and were taking medicines regularly. One patient (0.3%) had a copper concentration outside the reference range; 2 patients (0.6%) had folic acid concentrations outside the reference range. The corresponding number for vitamin B12 was 5 (2%), and for zinc 30 (10%). The systemic diseases with the highest rates were: hyperlipidaemia (n = 53, 17%), gastritis or gastric ulcer (n = 51, 16%), angina pectoris (n = 39, 13%), diabetes mellitus (n = 31, 10%), thyroid disease (n = 31, 10%), mild mental disorder (n = 27, 9%), hypertension (n = 18, 6%), cerebral infarction (n = 17, 6%), leiomyoma (n = 15, 5%) and anaemia (n = 15, 5%).     

Pediatric psychogenic nonepileptic seizures: A study of assessment tools

The goal of this study was to identify assessment tools and associated behavioral domains that differentiate children with psychogenic nonepileptic seizures (PNES) from those with epilepsy. A sample of 24 children with PNES (mean age 14.0 years, 14 female), 24 children with epilepsy (mean age 13.6 years, 13 female), and their parents were recruited from five epilepsy centers in the United States. Participants completed a battery of behavioral questionnaires including somatization, anxiety, and functional disability symptoms. Children with PNES had significantly higher scores on the Childhood Somatization and Functional Disability Inventories, and their parents reported more somatic problems on the Child Behavior Checklist (CBCL). Depression, anxiety, and alexithymia instruments did not differentiate the groups. Measures of somatization and functional disability may be promising tools for differentiating the behavioral profile of PNES from that of epilepsy. Increased somatic awareness and perceived disability emphasize the similarity of PNES to other pediatric somatoform disorders.     

A Japanese case series of 12 patients with esophageal eosinophilia

Background

Eosinophilic esophagitis (EoE) has been a rarely recognized condition in Asian populations, and its clinical manifestation is rarely documented. Our aim was to describe clinically, endoscopically, and pathologically the features of patients with esophageal eosinophilia, including EoE.

Methods

Twelve patients histologically proven to have esophageal eosinophilia were investigated. The histological diagnostic cutoff value was defined as a peak of ??15 eosinophils/high-power field (HPF) in esophageal biopsies. Symptoms, endoscopic and pathological findings, and treatment outcome were evaluated.

Results

Nine of the 12 patients were male and the 12 patients had a mean age of 47.7?years. Allergic conditions were concurrent in a total of 3 patients. Mild peripheral eosinophilia was observed in only 2 patients. The predominant symptom was solid-food dysphagia, but some patients complained of heartburn, or chest, epigastric, or back pain. Three asymptomatic subjects were also incidentally diagnosed during endoscopic screening. Linear furrows, concentric rings, and white exudates in the esophagus were frequently observed. In 4 of 5 patients who were administered a proton pump inhibitor (PPI), esophageal eosinophilia was histologically decreased or disappeared with symptom relief and endoscopic improvement. In 2 patients unresponsive to PPI, topical steroid therapy, administered by the swallowing of fluticasone propionate, led to symptomatic and histological remission.

Conclusions

The endoscopic recognition of linear furrows, concentric rings, and white exudates is important in the diagnosis of eosinophilic esophageal inflammation. In a subset of patients this condition improves clinicopathologically with PPI treatment, and typical EoE, as strictly defined by unresponsiveness to PPI, appears to be a rather rare condition.     

The selective serotonin reuptake inhibitor fluvoxamine suppresses post-feeding hyperactivity induced by food restriction in rats

Previous studies demonstrated that rats allowed access to running wheel with food restriction schedules run excessively. This hyperactivity consisted of a pre-feeding activity (an increase in running activity before the feeding time, also termed food-anticipatory activity: FAA) and a post-feeding activity (an increase in running activity after the feeding time, succeeding activity: SA). Here we evaluated the effect of fluvoxamine, a selective serotonin reuptake inhibitor, on food restriction-induced hyperactivity in rats. Furthermore, the effect of fluvoxamine on each of the FAA and the SA was also investigated. Rats were individually housed in a running-wheel cage under food restriction for 3 h per day, and running activity was measured for 7 consecutive days. This restricted feeding significantly increased the running activity and decreased body weight. Simultaneous administration of fluvoxamine (50 mg/kg/day, p.o.) for 7 days suppressed the increase in running activity (P<0.05) with no modification of the decrease in body weight or food intake. Analysis of each activity revealed that fluvoxamine's efficacy was observed only in the SA (p<0.01). These results suggest that repeated treatment with fluvoxamine attenuates the hyperactivity, which is exclusively dependent on the substantial reduction in the SA.     

Long-Term Survival After Repeat Resections of Metastases in Liver, Lung, and Stomach from Sigmoid Colon Cancer: Report of a Case

A 74-year-old female patient underwent a simultaneous colectomy and hepatectomy for sigmoid colon cancer and its hepatic metastases. Six months later she underwent a hepatectomy for recurrent hepatic metastases; then 10 months later, a pulmonary resection for pulmonary metastasis; and 24 months later, a partial gastrectomy for gastric metastasis. As of December 2005, at 7 years 6 months after the first surgery and at 4 years after the last surgery, the patient is still alive with a good quality of life and no sign of recurrence.     

Seizure emergency plans: patient results from a cross-sectional epilepsy survey

Guidance for seizure emergency plans exists, although their impact and extent of use in patients with epilepsy are undetermined. This study's primary purpose was to measure the estimated use and content of seizure emergency plans. Secondary objectives included measuring: disease severity, quality of life, productivity, and adherence among patients with and without a plan. An online survey was conducted among 408 patients with epilepsy (ages 18-64) who took one or more antiepileptic drugs. Only 30% of patients reported having a plan, which included avoiding injury, notifying a physician, resting/relaxing, and seeking emergency assistance. Those with a plan were more likely to have experienced more seizures in the past year, to have missed school/work, to have incurred injury, to have visited the ER, to have been hospitalized, to fear additional seizures, and to have lost a job. Seizure emergency plans appear to be reserved for adults with more severe disease, but there may be clinical benefits to developing a plan for all adult patients with epilepsy.