Biotin deficiency during total parenteral nutrition: its clinical manifestation and plasma nonesterified fatty acid level

We report a case of biotin deficiency developed in a 25-yr-old man with Crohn's disease who had been on total parenteral nutrition for more than 9 months. His cutaneous, ophthalmic, and neurologic manifestations were characteristic of this disease entity described in literature. In particular, the appearance of his face deserves to be called "biotin deficiency facies." After administration of biotin the low plasma nonesterified fatty acid level promptly returned to normal. This phenomenon may prove to serve as a convenient means for the purpose of detecting biotin deficiency.     

Lobectomy by video-assisted thoracic surgery for lung cancer patients aged 80 years or more.

To clarify the usefulness of video-assisted lobectomy for lung cancer patient aged 80 years old or more, a retrospective study was conducted to evaluate the clinical outcome. Between 1982 and 2001, 914 patients underwent surgery for primary lung cancer at the Nippon Medical School Hospital. Among them, 32 patients underwent lobectomy, including 17 with a mean age of 82 years (range, 80 to 91 years) who underwent video-assisted lobectomy and 15 with a mean age of 82 years (range, 80 to 86 years) who underwent lobectomy by standard thoracotomy. Of these 32 patients, clinical outcome was evaluated retrospectively. Mortality was 4 (12.5%) of 32 patients consisting of 3 (20%) of 15 who underwent lobectomy by standard thoracotomy and 1 (5.9%) of 17 who underwent video-assisted lobectomy. Single variate analyses revealed that the presence of preoperative cardiopulmonary disease, 0.6 L or more of predicted postoperative forced expiratory volume in one second/m(2), 700 ml or more of blood loss, five hours or more of duration of operation and two or more of postoperative complications were considered as risk factors regarding mortality within three months postoperation. Among the patients who underwent lobectomy with mediastinal lymph node dissection, the 5-year survival rate at stage I (IA+IB) was 55.6% for patients who underwent video-assisted lobectomy and 0% for patients who underwent lobectomy by standard thoracotomy (IA=2, IB=2). Video-assisted lobectomy for lung cancer patients aged 80 years or more is considered to offer an acceptable clinical outcome. However, further observation on prognosis is necessary.     

Survey of malignant pleural mesothelioma treatment in Japan: Patterns of practice and clinical outcomes in tomotherapy facilities

We conducted a nationwide survey of tomotherapy for malignant pleural mesothelioma (MPM) in Japan. Fifty-six facilities were surveyed and data on 31 patients treated curatively between 2008 and 2017 were collected from 14 facilities. Twenty patients received hemithorax irradiation after extrapleural pneumonectomy (EPP) (first group). Five patients received irradiation without EPP (second group), while six received salvage radiotherapy for local recurrence (salvage group). Among the seven patients not undergoing EPP, five (four in the second group and one in the salvage group) were treated with lung sparing pleural irradiation (LSPI) and two with irradiation to visible tumors. Two-year overall survival (OS) rates in the first and second groups were 33% and 60%, respectively (median, 13 vs 30 months, P = 0.82). In the first and second groups, 2-year local control (LC) rates were 53 and 67%, respectively (P = 0.54) and 2-year progression-free survival (PFS) rates were 16% and 60%, respectively (P = 0.07). Distant metastases occurred in 15 patients in the first group and three in the second group. In the salvage group, the median OS was 18 months. Recurrence was observed in the irradiated volume in four patients. The contralateral lung dose was higher in LSPI than in hemithorax irradiation plans (mean, 11.0 ± 2.2 vs 6.1 ± 3.1 Gy, P = 0.002). Grade 3 or 5 lung toxicity was observed in two patients receiving EPP and hemithorax irradiation, but not in those undergoing LSPI. In conclusion, outcomes of EPP and hemithorax irradiation were not satisfactory, whereas LSPI appeared promising and encouraging.     

Similarity of isozyme pattern of serum lactate dehydrogenase following treatments with O,O,S-trimethyl phosphorothioate and paraquat

Oral administration of O,O,S-trimethyl phosphorothioate (OOS-TMP) causes delayed mortality and lung injury in rats. The present study was carried out to determine whether serum lactate dehydrogenase (LDH) activity and its isozyme pattern were capable of detecting lung injury and possible other organ damages caused by OOS-TMP. Carbon tetrachloride (CCl4, 1 ml/kg, i.p., 24 h) and paraquat (25 mg/kg, i.p., 48 h) were selected as standard chemicals for liver injury, and lung and kidney injuries, respectively. The activity of serum LDH increased to 4 times above control following treatment of rats with OOS-TMP (20 mg/kg, p.o., 72 h). Treatment with CCl4 increased the activity to 8 times while paraquat only slightly increased the activity. Isoelectrophoresis of serum samples showed that OOS-TMP increased the activities of isozymes LDH 1 and LDH 2. This isozyme pattern was similar to the pattern of paraquat but quite different from the pattern in animals treated with CCl4, where LDH 5 was most predominant, or in control animals. Thus, the isozyme pattern strongly suggests that OOS-TMP causes the similar organ damage evoked by paraquat, lung and kidney.     

Distal arch replacement for aortic aneurysm associated with pseudocoarctation through the L-incision approach

We report the case of a 16-year-old boy in whom we successfully repaired a distal aortic arch aneurysm associated with pseudocoarctation using double aortic cannulation and antegrade selective cerebral perfusion through the L-incision approach. This approach provided excellent exposure from the ascending aorta to the descending aorta, which enabled total body perfusion. We avoided cardiac arrest and hypothermic circulatory arrest during the surgery. The L-incision approach could be a better alternative for aortic arch surgery in adolescents.     

Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection

Open in a separate window OBJECTIVESThe management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke.METHODSIn the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31–659) min.RESULTSAmong the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8–735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0–31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity.CONCLUSIONSCTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.