Brain lesions in the course of generalised tetanus

A 47-year-old woman developed left hemiparesis primarily affecting the lower limbs during the course of severe generalised tetanus. MRI on the 82nd hospital day revealed cortical and subcortical lesions predominantly in the right frontal and parietal lobes in addition to marked brain atrophy. Three months later, the enhancing lesions were still present on follow up MRI. We postulate that structures above brainstem may be involved in severe generalised tetanus.     

Usefulness of antegrade selective cerebral perfusion during aortic arch operations

BACKGROUND: To evaluate the safety and usefulness of antegrade selective cerebral perfusion (SCP) during arch aneurysm or aortic dissection operations. METHODS: Between January 1986 and December 2001, 330 patients underwent aortic arch repair using SCP. Operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and systemic circulatory arrest in most cases. In all, 89 patients (27%) were operated on for acute aortic dissection, 77 (23%) for chronic aortic dissection, and 164 (50%) for degenerative aneurysm. Total arch replacement using a branched graft was performed in 288 patients (94%). Mean SCP time was 86.2 +/- 28.5 minutes. RESULTS: The overall in-hospital mortality rate was 11.2% (falling to 3.2% in the 124 patients operated on between 1997 and 2001). Independent determinants of hospital mortality were pump time, renal/mesenteric ischemia, chronic renal failure, increasing age, period of operation, and nonuse of four-branched arch graft. The overall postoperative incidences of temporary and permanent neurologic dysfunction were 4.2% and 2.4%, respectively. There was no significant correlation between SCP time and in-hospital mortality or neurologic outcome. CONCLUSIONS: Selective cerebral perfusion is a reliable technique for cerebral protection and it facilitates complex and time-consuming total arch replacement.     

Impact of an aggressive surgical approach on surgical outcome in type A aortic dissection

BACKGROUND: To evaluate the impact of an aggressive surgical approach on early and late outcome in type A aortic dissection. METHODS: From 1983 to 2001, 240 patients underwent operation for acute (n = 138) and chronic (n = 102) type A aortic dissection. The extent of distal aortic resection included the ascending aorta in 39 (16%) patients, hemiarch (HAR) in 47 (20%), and total arch (TAR) in 154 (64%), including 19 patients who also had their descending aorta replaced (DAR). RESULTS: The in-hospital mortality did not differ between TAR with or without DAR and other more conservative techniques (12.3% versus 16.3%). Actuarial survival at 10 years including in-hospital mortality was 72.4% +/- 3.3% and freedom from reoperation was 77.2% +/- 3.6% for all patients: neither was influenced by the extent of distal aortic resection or acuity of aortic dissection. Multivariate analysis revealed younger age and failure to resect the intimal tear to be independent determinants for late reoperation. However, in contrast to 22 patients who had more conservative operations, none of the patients with TAR required reoperation on the aortic arch through a sternotomy incision. CONCLUSIONS: An aggressive surgical approach did not adversely influence early and late survival following type A aortic dissection; it reduced the necessity of late reoperation and facilitated distal aortic reoperation.     

Minimal residual disease in early phase of chemotherapy reflects poor outcome in children with acute lymphoblastic leukemia--a retrospective study by the Children's Cancer and Leukemia Study Group in Japan

We analyzed the minimal residual disease (MRD) in 50 children with acute lymphoblastic leukemia (ALL) by amplifying the clonally rearranged T-cell receptor (TCR) gamma/delta chain and/or immunoglobulin (Ig) kappa chain gene using the allele-specific-PCR method. All children were treated according to the protocols of the Children's Cancer and Leukemia Study Group of Japan (CCLSG). The patients were stratified into four risk-groups according to the leukocyte count and age at diagnosis. We prospectively sampled the patients' bone marrow at 1 month (point 1) and 3 months (point 2) after the initiation of chemotherapy and quantitated the MRD retrospectively. The results of MRD were closely related with the clinical outcome. The relapse rate of the patients MRD-positive at points 1 and 2 was 46% (6/13) and 86% (6/7), respectively, whereas those MRD-negative results at point 1 and 2 were 13% (3/13) and 3% (3/30), respectively. We found significant differences in the event-free survival between MRD-positive children and MRD-negative children like the reports, which have been made by BFM and EORTC groups. We conclude that MRD in an early phase of chemotherapy can be a good predictor of the prognosis of childhood ALL regardless of the protocol of chemotherapy or race.     

Survivin an important determinant for prognosis in adult T-cell leukemia: a novel biomarker in practical hemato-oncology

Survivin is a 16.5-kDa protein that belongs to the inhibitor of apoptosis (IAP) family. It is expressed at high levels in the G2/M phase and is rapidly down-regulated after cell-cycle arrest. It was suggested that survivin plays a pivotal role in linking cell death and cell proliferation. Although present during fetal development, survivin disappears in terminally differentiated adult tissues. Its expression is aberrantly enhanced in transformed cell lines, and in all the most common human cancers. Adult T-cell leukemia (ATL), which is abundant with Fas (Apo-1/CD95), has the characteristic feature of high tumor burden, suggesting that ATL cells probably prolong their lives as a result of escape from apoptosis. Survivin is prominently and consistently expressed in all cases of ATL and ATL cell lines. Its mRNA expression levels among the subtypes of ATL and ATL cell lines are characteristic and informative, low in chronic type, low to high in acute type and extremely high in ATL cell lines. In addition, when the survivin mRNA expression is higher, the survival of the patient is shorter. Its overexpression may account for a growth advantage in vivo and subsequently the malignant behavior of ATL. So quantification of survivin mRNA is important for clinical laboratory examinations. Among all of the current clinical tests for survivin mRNA quantification, the real time PCR is desirable. Despite some technological problems of standardization, quantification of survivin mRNA was shown to be a biological marker for clinical stages or minimal residual disease (MRD).     

Foci identification of spike discharges in the EEGs of sleeping El mice based on the electric field model and wavelet decomposition of multi monopolar derivations

We report on spike discharges in the EEGs of sleeping El mice, which are considered to be homologous to the state seen in human epileptic patients. The discrete wavelet transform (DWT) was used to decompose the EEGs derived from seven electrodes, with the primary spike frequency detected in the 15.6-7.8 Hz detail. The synchronicity of the spikes was evaluated in 98 samples. We succeeded in detecting the foci of the spikes by applying the electric field model, in which the surface potential was expressed as a function of distance between the focus and each electrode based on Gauss' theorem. The foci were obtained in 73 of 91 spikes so evaluated. In 69 of these 73 spikes, the calculated foci occurred within the brain, with none of the foci occurring at identical positions. The distribution occurred in relatively deeper brain regions, suggesting involvement of the paleocortex rather than the hippocampal system. The present study provides reasonable grounds for an explanation of the EEG using the electric field model supported by efficient foci detection of the spikes in a one-to-one correspondence. This paradigm will be applicable to all animal species including humans and will be helpful in the detection of the epileptic focus and in obtaining an insight into the mechanisms of spike genesis.     

Absence of association between the Fc gamma receptor IIIA-176F/V polymorphism and the severity of malaria in Thai

Human Fc gamma receptor (Fc gamma R) genes form a clustered gene family, which consists of Fc gamma RIIA, IIB, IIC, IIIA, and IIIB genes, on chromosome 1q23. We previously reported that the Fc gamma RIIA-131H/H genotype in combination with the Fc gamma RIIIB-NA2 allele is associated with susceptibility to cerebral malaria, and that such an association can be caused by linkage disequilibrium (LD) between these polymorphisms and the primary associated gene(s) in this region. Fc gamma RIIIA is known to exhibit the genetic polymorphism Fc gamma RIIIA-176F/V coded for different affinity to IgG1 and IgG3. In this study, we examined a possible association between Fc gamma RIIIA-176F/V polymorphism and severity of malaria in 462 adult Thai patients with Plasmodium falciparum malaria. The frequencies of Fc gamma RIIIA-176V among patients with mild malaria, with non-cerebral severe malaria, and with cerebral malaria were 32.7%, 29.9%, and 36.3%, respectively. This polymorphism showed neither positive nor negative association with the severity of malaria. Thus, we concluded that the association of Fc gamma RIIA-131H/R and Fc gamma RIIIB-NA1/NA2 polymorphisms with cerebral malaria in Thailand is not due to the LD caused by Fc gamma RIIIA-176F/V.