Endoscopic Hemostasis in Patients with Dieulafoy Ulcer

Abstract: Dieulafoy ulcer was defined based on endoscopic findings as an ulcer (1) of 10 mm or less in diameter, (2) of grade Ul-ll or less and (3) showing vascular protrusion in its floor. We evaluated the clinical background and endoscopic findings of Dieulafoy ulcer and studied the usefulness and problems of endoscopic hemostasis. Patients with Dieulafoy ulcer accounted for 8.7 % of 321 patients with diseases treated by endoscopic hemostasis excluding sclerotherapy. The patients were predominantly males, and their average age was 61 years. An association with other diseases was noted in 21 patients (75%). Therefore, more than 50 % of the patients were treated with NSAIDs such as aspirin. The most frequent site of this disease was the posterior wall of the upper gastric body. In particular, the ulcer was located in the superior duodenal angle. In six of the 28 patients, the ulcer and the exposed vessel were similar in size. Endoscopic hemostasis was successful in 25 patients (89%). Hemostasis was acheived by emergency surgery in two and by transcatheter arterial embolization (TAE) in one. No patient showed recurrence. Most Dieulafoy ulcers can be conservatively treated by endoscopic hemostasis. However, a few cases can not be managed conservatively and shock develops due to fatal massive bleeding. In such patients, the timing of TAE or surgery must be carefully considered.     

Characterization of renal tubular damage in preterm infants with renal failure

This study attempts to clarify the characteristics of renal tubular damage in preterm infants with renal failure. Sixty-one neonates (17 term and 44 preterm infants) were divided into three groups: 15 infants with intrinsic renal failure (IRF), five term and 10 preterm; 19 with pre-renal renal failure (PRF), five term and 14 preterm; and 27 without renal dysfunction (control), seven term and 20 preterm. Urine was collected for an 8 h period on the 2nd or 3rd day of life to determine the following parameters: creatinine clearance (Ccr), fractional excretion of sodium (FENa), urinary N-acetyl-beta-D-glucosaminidase (NAG) index and endothelin-1 (ET-1) excretion. Parameters of renal tubular function and/or renal tubular damage such as FENa, NAG index and ET-1 excretion were considered as a useful marker to differentiate IRF from PRF in preterm infants. However, these parameters were significantly elevated in preterm infants with PRF. These findings led us to make the following speculations: (i) renal tubular damage may easily occur in preterm infants; and (ii) there still remains difficulty in differentiation between IRF and PRF using Ccr instead of the fluid challenge test.     

Photic and Bemegride Activation of Triphasic Waves in Portal-Systemic Encephalopathy

Photic stimulation from 0.5 to 20cps flickers was given on 7 cases of portal-systemic encephalopathy. The triphasic waves were increased by the stimulation (mostly appearing synchronously with 2.0–3.5 cps of flicker) in all cases at least more than once in repeated EEG examinations. Bemegride activation was performed on three cases who had theta and alpha background activity with very poor delta waves. The triphasic waves increased in number remarkably in two cases and poorly in one. Based on these reactions to the photic stimulation and bemegride activation, it was suggested that the triphasic waves and epileptic discharges might have some similar mechanism in their production. (This study was presented at 18th annual meeting of Japan EEG Society, 1969     

Primary Experiences with Robot-assisted Navigation-based Frameless Stereo-electroencephalography: Higher Accuracy than Neuronavigation-guided Manual Adjustment

The use of robot-assisted frameless stereotactic electroencephalography (SEEG) is becoming more common. Among available robotic arms, Stealth Autoguide (SA) (Medtronic, Minneapolis, MN, USA) functions as an optional instrument of the neuronavigation system. The aims of this study were to present our primary experiences with SEEG using SA and to compare the accuracy of implantation between SA and navigation-guided manual adjustment (MA). Seventeen electrodes from two patients who underwent SEEG with SA and 18 electrodes from four patients with MA were retrospectively reviewed. We measured the distance between the planned location and the actual location at entry (De) and the target (Dt) in each electrode. The length of the trajectory did not show a strong correlation with Dt in SA (Pearson''s correlation coefficient [r] = 0.099, p = 0.706) or MA (r = 0.233, p = 0.351). De and Dt in SA were shorter than those in MA (1.99 ± 0.90 vs 4.29 ± 1.92 mm, p = 0.0002; 3.59 ± 2.22 vs 5.12 ± 1.40 mm, p = 0.0065, respectively). SA offered higher accuracy than MA both at entry and target. Surgical times per electrode were 38.9 and 32 min in the two patients with SA and ranged from 51.6 to 88.5 min in the four patients with MA. During the implantation period of 10.3 ± 3.6 days, no patients experienced any complications.     

Mathieu and Barcat repair with a V incision sutured meatoplasty for secondary hypospadias surgery

AIM: Today single-stage methods are more frequently selected for hypospadias repair than multistaged methods, but complications cannot always be avoided. We employed two kinds of meatal based flip-flap urethroplasty procedures for those with an unsuccessful primary hypospadias repair. PATIENTS AND METHODS: From 1997 to 2005, a meatal based flip-flap urethroplasty was performed as a secondary hypospadias surgery on 17 patients. Basically we attempted the Mathieu repair, but when the wings of the glans were not generously widened and the urethral groove was not sufficiently deep we applied the Barcat procedure. While 11 patients were repaired with the Mathieu technique, six patients underwent the Barcat repair. The V incision sutured meatoplasty was added to obtain a natural ventral slit-like meatus. RESULTS: Ten of the 11 patients who underwent the Mathieu repair had a good outcome, but one patient developed a urethrocutaneous fistula. None of the six patients repaired with the Barcat procedure encountered postoperative complications. Cosmetically, a vertical slit was constructed near the normal neomeatus with the Mathieu and V incision sutured (MAVIS) meatoplasty and the Barcat and V incision sutured (BAVIS) meatoplasty. CONCLUSIONS: The Mathieu or the Barcat meatal based flip-flap urethroplasty procedure is feasible as a salvage surgery for those with relatively short urethral defects and adequate mobile ventral skin if an exact procedure is selected. Excellent cosmetic results could be obtained by adding the technique of V incision sutured meatoplasty.     

巴西日圆线虫诱导小鼠T辅助细胞的变化对伯氏疟原虫感染的影响

[目的 ]观察预感染巴西日圆线虫后 ,小鼠抵御伯氏疟原虫攻击感染的能力 ,并着重探讨T辅助细胞亚型在感染过程中的变化以及这些变化对宿主免疫力和预后的影响。 [方法 ]皮下注射巴西日圆线虫感染C5 7BL/ 6小鼠 ,建立线虫预感染模型 ,于 3wk后腹腔注射伯氏疟原虫ANKA株攻击感染小鼠。观察每天原虫血症变化情况 ,并于疟原虫感染后 0、3和 9d取脾 ,提取RNA ,用RT PCR扩增法定性观察细胞因子IFN γ和IL 4的变化。[结果 ]与对照组相比 ,实验组感染疟原虫后 ,原虫血症的峰值出现时间明显延长 ,小鼠对疟原虫感染的耐受程度以及小鼠生存时间显著提高。实验组Th2型细胞合成IL 4的量在疟原虫感染 0d时明显高于对照组 ;而在 3与 9d时两组均异常升高。Th1型细胞合成IFN γ的量在疟原虫感染后 3d时实验组高于对照组 ,但在 9d时实验组IFN γ有所下降。 [结论 ]预感染巴西日圆线虫的小鼠具有较高的抗感染能力。但在攻击感染疟原虫后Th2型细胞被提前激活而抑制了Th1型细胞的正常功能 ,最终仍导致小鼠死亡。     

Skewed X chromosome inactivation in fraternal female twins results in moderately severe and mild haemophilia B

Summary. Female carriers of haemophilia B are usually asymptomatic; however, the disease resulting from different pathophysiological mechanisms has rarely been documented in females. In this study, we investigated the mechanisms responsible for haemophilia B in fraternal female twins. We sequenced the factor IX gene (F9) of the propositus, her father, a severe haemophilia B patient and the other family members. X chromosome inactivation was assessed by the methylation‐sensitive HpaII‐PCR assay using X‐linked polymorphisms in human phosphoglycerate kinase 1 gene (PGK1) and glutamate receptor ionotropic AMPA 3 gene (GRIA3). The twins were found to be heterozygotes with a nonsense mutation (p.Arg384X) inherited from their father. The propositus, more severely affected twin, exhibited a significantly higher percentage of inactivation in the maternally derived X chromosome carrying a normal F9. The other twin also showed a skewed maternal X inactivation, resulting in a patient with mild haemophilia B. Thus, the degree of skewing of maternal X inactivation is closely correlated with the coagulation parameters and the clinical phenotypes of the twins. Furthermore, we identified a crossing‐over in the Xq25–26 region of the maternal X chromosome of the more severely affected twin. This crossing‐over was absent in the other twin, consistent with their fraternal state. Differently skewed X inactivation in the fraternal female twins might cause moderately severe and mild haemophilia B phenotypes, respectively.