Prophylactic calcium administration for hyperkalemia in extremely low birthweight infants

The objective of this study was to clarify the relationship between the blood potassium and calcium levels, and the efficacy of prophylactic calcium (Ca) administration early in life for nonoliguric hyperkalemia in extremely low birthweight (ELBW) infants. This was a retrospective study including 55 ELBW infants with gestational age less than 26 weeks (mean, 24.4 weeks; mean body weight, 681 g). The plasma potassium concentration and whole blood ionized calcium (iCa) concentration were measured every 2 to 3 hours. Laboratory data obtained up to 24 hours after birth were collected. The infants were divided into two groups based on whether or not Ca gluconate was administered prophylactically starting at admission (prophylactic and nonprophylactic group). There was a negative correlation between the plasma potassium and iCa levels at 12 and 24 hours, and the maximum plasma potassium level was higher in the hypocalcemia group (minimum iCa level, < 0.9 mmol/L) than in the normocalcemia group. The iCa level was significantly higher and the plasma potassium level was significantly lower in the prophylactic group than in the nonprophylactic group at 12 and 24 hours. The increment in the plasma potassium level at 24 hours compared with that at admission was significantly lower in the prophylactic than in the nonprophylactic group. Nonoliguric hyperkalemia may be attenuated by maintaining the iCa level within normal limits by prophylactic Ca administration early in life. Prospective studies are needed to confirm this.     

Prenatal foetal diagnosis of partial trisomy 3q and monosomy 13p due to a maternal balanced rearrangement

The authors describe a case of a male foetus whose ultrasound at 20 weeks' gestation revealed cystic hygroma, cleft lip and ventricular septal defect. Amniotic fluid cytogenetics using GTG banding showed a 46,XY,der(13)t(3;13)(q12;p11.1) rearrangement, and fluorescence in situ hybridization (FISH) delineated the relevant breakpoints. Familial studies identified a maternal balanced translocation involving chromosomes 3 and 13. The post-mortem examination confirmed the prenatal ultrasound findings.     

Relationship between lifestyle scores and salivary stress markers cortisol and chromogranin A

The authors evaluated individuals' lifestyles and investigated the relationship between lifestyle scores and the incidence of salivary stress markers cortisol and chromogranin A (CgA). Saliva samples from 173 healthy male workers were tested by enzyme-linked immunosorbent assay for salivary cortisol and CgA levels. Questionnaires concerning lifestyle were administered: respondents aged 20-39 years who had good scores for comprehensive lifestyle showed significantly lower levels of cortisol than did respondents with moderate or poor comprehensive lifestyle scores. Respondents aged 40-59 who scored better for general lifestyle than they did during the previous year showed significantly lower levels of CgA than did respondents reporting no improvement. These findings suggest that levels of salivary cortisol may be affected by current circumstances and that levels of CgA may be affected by changes in comprehensive lifestyle.     

Preparation of pamphlets to teach the technique of home parenteral nutrition aiming at timely back home

The home drip infusion is a stressful procedure for both patients and families under HPN at home. Effective and reliable guidance for drip infusion management should be provided while patients are still at the hospital to realize reliable home care. We revised the HPN Guidance Manual and report the process in this article. We revised the manual according to the principles that "the guidance is subdivided into 3 steps so that the contents of the guidance can be adjusted for individual patients", that "a lot of photos and illustrations for frequently used 2 models are placed" and that "a video is prepared to make the most of the impact motion pictures can give". We want to use the manual in future clinical practices.     

Rapid communication: pure robot-assisted laparoscopic ureteral reimplantation for ureteral stricture disease: case report

BACKGROUND AND PURPOSE: The role of the da Vinci robot is slowly being defined in minimally invasive urologic surgery. We report its use in the management of ureteral stricture disease. CASE REPORT: A 42-year-old man with recurrent kidney stone disease was found to have a left distal-ureteral stricture. After failure of endoscopic treatment, a robot-assisted laparoscopic ureteral reimplantation was performed. The total operative time was 210 minutes. The estimated blood loss was <50 mL. There were no intraoperative or postoperative complications. Total analgesic use was 30 mg of morphine. The hospital stay was 5 days. CONCLUSION: Pure robot-assisted laparoscopic ureteral reimplantation is a safe and feasible approach to the management of ureteral stricture disease.     

Protective dural flap for bone drilling at the paraclinoid region and porus acusticus--technical note

A new method was developed to avoid the risk of injury to the cranial nerves and vessels during intradural bone resection at the paraclinoid region and porus acusticus. The semicircular dural flap is pulled out with a thread over the anterior clinoid process or the porus acusticus. The flap is extended over the underlying structures with a tapered spatula to create adequate space for drilling the bone. The site for drilling was adequately exposed and bone was drilled away smoothly without damaging the underlying vessels and nerves in 10 patients with paraclinoid aneurysms and in seven patients with vestibular schwannomas. This "protective dural flap" method provides wide exposure for drilling, protects the underlying structures, and allows quick inspection during bone resection.     

Tuberculosis control in Kawasaki City--promoting the DOT program

Kawasaki City initiated the DOT (Directly Observed Therapy) program in 2000 to improve tuberculosis (TB) control in the homeless persons and individuals living in temporary subsidized housing. The program was implemented as an additional program to the city's control policy of mass TB screenings for these groups. The DOT program was implemented through participation of numerous agencies sharing common goals. Through coordination and cooperation, a strategy suitable for the regional level was developed. Sectors involved were not only the TB control staff within the public health centers but also the entire public health centers, the welfare administrative division, the city's TB task force and homeless task force, and regional medical institutions. With the implementation of the DOT program, proper medical treatment, improved patient care, and various other measures were performed, and this led to the strengthening of TB control not only in designated DOT-implemented areas but also in the entire city. As a result, the treatment outcomes improved, and incidence rate of TB began to decrease.     

Cervical varix accompanied by placenta previa in twin pregnancy

BACKGROUND: Uterine cervical varix is a rare complication in pregnant women and can be the cause of obstetric hemorrhage in the vagina resulting in adverse events for both the mother and fetus. CASE: A 34-year-old Japanese woman was hospitalized at 18 weeks gestation because of cervical varix and placenta previa. Prophylactic tocolysis successfully controlled the obstetric hemorrhage. At 27 weeks gestation, emergent cesarean section was performed because of intractable hemorrhage from the marginal placenta previa. Intraabdominal findings revealed no vascular malformation of the uterus, and the operation was performed uneventfully. A speculum examination of the vagina and cervix at 1 month postpartum were unremarkable. CONCLUSION: It is important to recognize the clinical features and available treatments for cervical varix.     

Physiological actions of diacylglycerol outcome

PURPOSE OF REVIEW: Recent developments in molecular biology have led to the recognition of food-derived lipids and their metabolites, including cholesterol, fatty acids, bile acids and litocholic acids, as ligands of each corresponding nuclear receptor and regulators of key physiological events. Intake of diacylglycerol, which comprises up to 10% of glycerides in plant-derived edible fats and oils and contains 70% of the unusual 1,3-species, has been shown to affect lipid and glucose metabolism. Effects include lowering of plasma triacylglycerol, decreasing postprandial hyperlipidemia and hemoglobin A1c, increasing energy expenditure, and reducing diet-induced obesity compared with triacylglycerol, which has a similar fatty acid composition. This review summarizes recent research into the metabolic effects and possible mechanisms of diacylglycerol outcome. RECENT FINDINGS: Reacylation to triacylglycerol in small intestinal cells was found to be slower with diacylglycerol feeding than triacylglycerol feeding. Expression of mRNA of beta-oxidative and uncoupling proteins 2 was also increased in liver and/or intestinal cells on feeding diacylglycerol compared with triacylglycerol. Because the energy value and absorptive and digestive properties are similar, the different effects of diacylglycerol compared with triacylglycerol are due to their structural differences. SUMMARY: The stimulation of enzyme activities responsible for beta-oxidation and regulation of lipid metabolism-related gene expression in the small intestine may contribute to reduced postprandial hyperlipidemia as well as to increased energy expenditure, which result in suppression of diet-induced obesity. Further analysis is required to elucidate the chemical and biological properties of diacylglycerol, especially of 1,3-diacylglycerol, on digestion, absorption and metabolic processes that may provide new insights for managing a lifestyle-related chronic disease such as the metabolic syndrome.