Growth Failure as the Presenting Symptom of Crohn's Disease

Short stature is a common symptom of Crohn's disease in children, but it is rarely the chief complaint. We have encountered 5 pati?nts whose major complaint was stunted growth and poor weight gain. Only one patient had moderately severe diarrhea, abdominal pain and weight loss, while the remaining patients exhibited mild abdominal symptoms elicited only by probing questions. Bone age was retarded in all. Sedimentation rate was elevated in 3 patients, and 4 had anemia. Small bowel series revealed typical findings of Crohn's disease in all. Two patients had surgical treatment, and 3 received nutritional supplement and steroid therapy. It is concluded that in the patient with stunted growth, careful history taking is essential. A work-up to rule out inflammatory bowel disease is indicated, especially if an elevated sedimentation rate and/or anemia are present, even in the absence of clear-cut abdominal compliants.     

Biological variability of biochemical markers of bone turnover in healthy women

To investigate day-to-day biological change of biochemical makers of bone turnover, we measured eight markers for 5 days in 10 healthy women. They aged 26-41 years (mean age; 31.1 years old), and had regular menstrual cycles. Fasting second void urine and blood was collected from them on five successive days. As serum marker, Estradiol (E2), intact PTH (i-PTH), Bone-specific alkaline phosphatase (BAP), and serum C-telopeptide (S-CTX) were measured. As urinary markers, urinary CTX (U-CTX), N-telopeptide (NTX), pyridinoline (Pyr) and deoxypyridinoline (Dpyr) were measured. Day-to-day physiological variations were different between bone markers. Variability of serum markers was less than that of urinary markers. Moreover, in the comparison of the same molecular marker, CTX, the variability of S-CTX was less than U-CTX. One should consider physiological variation of the marker to evaluate whether the change of the biochemical marker of bone turnover is significant or not.     

Randomized comparative study of omeprazole and famotidine in reflux esophagitis

BACKGROUND: Although proton pump inhibitors (PPI) and H2-receptor antagonists (H2-RA) are routinely used in the treatment of reflux esophagitis (RE), no consensus has been reached yet as to whether the first-choice drug should be PPI or H2-RA. In this study, the effects of omeprazole (OMP) and famotidine (FAM) on RE have been examined in a randomized comparative study. METHODS: Protocols of OMP 20 mg once daily or FAM 20 mg twice daily for 8 weeks were allocated to 56 cases with RE at random, using an envelope randomization method. Their efficacy in achieving healing was examined endoscopically and a relief from subjective symptoms was compared. RESULTS: Patient's background such as sex, age, recurrence, hiatal hernia, smoking and drinking habits, and complications, and the severity of esophagitis at the time of enrolment were not significantly different between the two groups. Healing in the OMP group and the FAM group was observed in 72 and 32% (P = 0.025) of patients at week 4 and 95 and 53% (P = 0.003) of patients at week 8, respectively. Subjective symptoms were relieved more frequently in the OMP group (at week 2, 67% compared with 29%, P = 0.005; at week 4, 95% compared with 55%, P = 0.009), but this superiority was not significant at week 8 (94% compared with 65%, P = 0.085). No serious adverse events occurred. CONCLUSIONS: Omeprazole provided quicker healing and a greater relief from subjective symptoms than did FAM in the treatment of RE, and was considered more suitable as a first-choice drug.     

The current state of neurosurgery in Japan

JAPAN HAS TWO large neurosurgical societies, the Japan Neurosurgical Society (JNS) and the Japanese Congress of Neurological Surgeons (Japanese CNS). The JNS was founded in 1948, and the Japanese CNS in 1981. The total number of neurosurgeons in Japan exceeds 7500, with 5432 board certified. There are 1340 training centers for neurosurgery in Japan; they are classified into two categories: Category A centers and Category C centers (training subcenters). For a neurosurgeon to be eligible to take the specialty board examination, he or she is required to have finished at least 6 years of training at a designated training center. A characteristic of Japanese neurosurgery is that neurosurgeons are engaged not only in surgical operations but also in various related activities, including performing radiological diagnostic procedures, such as angiography and endovascular surgery; working in the emergency room; and sometimes participating in neurorehabilitation and gamma knife treatment. In addition, a large number of neurosurgeons are engaged in research in various related fields. The JNS began to publish its official journal in 1948, initially in the Japanese language. Since 1990, the journal has been published exclusively in English (Neurologia Medico-chirurgica), whereas the official journal of the Japanese CNS is published in Japanese (Japanese Journal of Neurosurgery). Japan is blessed with advanced diagnostic and surgical technologies and instruments. They are available as needed throughout the country. Medical insurance is fully covered by the government or public insurance system; there is basically no private insurance in Japan. This article mentions socioeconomic problems relating to neurosurgical practice.     

Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases

OBJECTIVE AND IMPORTANCE: Treatment of one side in cases of dissecting aneurysms of the bilateral vertebral arteries (VAs) with subarachnoid hemorrhage may result in dissection or rupture on the contralateral side. CLINICAL PRESENTATION: Three patients presented with dissecting aneurysms of the bilateral VAs with subarachnoid hemorrhage. INTERVENTION: Two patients underwent trapping of the ruptured VA, with side-to-side anastomosis between the bilateral posteroinferior cerebellar arteries. One patient underwent resection of the ruptured VA, with interposition of a saphenous vein graft. Two patients died as a result of rupture of the contralateral VA dissecting aneurysm after surgery. One patient demonstrated development of an unruptured dissecting aneurysm in the contralateral VA 1 month after surgery. CONCLUSION: Surgical intervention to treat dissecting aneurysms of the bilateral VAs on one side carries the risk of rupture of the contralateral lesion. Increased hemodynamic stress may be important in the development and rupture of dissections in the contralateral VA.     

Versatility of scanning laser Doppler imaging to detect cutaneous perforators

Several perforator-based flaps have been developed recently and, although preoperative evaluation of perforator vessels is important, the conventional method using the Doppler flowmeter is still being used. The authors tried to identify perforator vessels in the abdominal region using scanning laser Doppler imaging and then compared the results with those obtained using an ultrasonic Doppler flowmeter in 10 healthy volunteers. The scanning laser Doppler detected several perforator vessels (range, 2-5 vessels; mean, 3.1 vessels) within a 7.5 x 7.5-cm area in the abdominal region. These results suggest that scanning laser Doppler imaging is a useful tool in the identification of perforator vessels.     

Partial left ventriculectomy. Past,present and future

Although discouraging clinical results and a lack of scientific evidence decreased the initial interest in partial left ventriculectomy (PLV), factors contributing to its success and failure have now been identified by clinical observation, theoretical analyses, and data from an international registry, which are herein reviewed to outline the current status and future role of this procedure as a treatment for heart failure. Based on the same concept, new and less-invasive approaches are now being developed to reduce the diameter of the left ventricle. While PLV has been practically abandoned, these experimental approaches appear promising because they can be applied for many more patients with better cardiac condition and preserved myocardial viability, factors associated with benefits of cardiac volume reduction.