Pulmonary involvement: a rare extraintestinal manifestation of ulcerative colitis

Ulcerative colitis (UC) is associated with a number of extraintestinal manifestations (EIMs) that may affect most organ systems. Among the EIMs, those involving the lung are rare. We report a case of pulmonary involvement and pyoderma gangrenosum in a patient with refractory UC. A chest computed tomography showed multiple nodular infiltrates in bilateral lungs. The patient had no respiratory symptoms. No infectious agents were detected. A transbronchial biopsy specimen showed nonspecific features. Prednisolone was initiated with significant improvement in the patient’s abdominal symptoms and pyoderma gangrenosum. Subsequent imaging after steroid therapy showed improvement of the pulmonary infiltrates. The patient’s abdominal symptoms relapsed when prednisolone was tapered. The patient subsequently received a proctocolectomy. Chest radiographs have shown resolution of pulmonary infiltrates. Because pulmonary involvement follows an independent course and a proctocolectomy may not be protective against a recurrence of pulmonary involvement, a careful follow-up should be continued.     

Objective assessment of internal stress in children during dental treatment by analysis of autonomic nervous activity

International Journal of Paediatric Dentistry 2012; 22: 331–341 Aims. The aim of this study was to assess the internal stress of children during dental treatment based on autonomic nerve activity and facial muscle activity. Methods. We recorded the electrocardiogram of children during the treatment of composite resin restoration and analysed autonomic nerve activity by means of power spectral analysis of heart rate variability. Simultaneously, electromyography (EMG) activity of the corrugator muscle was recorded in children during dental treatment, and the relationship between sympathetic nerve activity and corrugator EMG activity was analysed. Results. In all subjects, the mean sympathetic nerve activity was significantly higher during oral examination and after treatment compared with pre‐treatment. Depending on the sympathetic nerve responses to the other treatment procedures, the subjects could be classified into two groups: the stress group and the nonstress group. Sympathetic nerve activity was significantly higher during infiltration anaesthesia and cavity preparation compared with pre‐treatment activity in the stress group, whereas it was consistently lower than the pre‐treatment levels during most treatment procedures in the nonstress group. The mean amplitudes of the averaged corrugator muscle EMG during dental treatment did not differ between the stress and nonstress groups. Conclusion. The present results suggest that the measurement of autonomic nervous activity, especially sympathetic nervous activity, is quite useful in assessing the internal stress of children, even when no expressed sign of unease are present during dental treatment.     

Distributions of calcitonin gene-related peptide and substance P in the human maxillary sinus of Japanese cadavers

BackgroundSubstance P (SP) and calcitonin gene-related peptide (CGRP) are released by the nociceptive sensory nerve and are involved in blood flow, pain and inflammation in the nasal mucosa. The purpose of this study was to assess the distribution of the SP and CGRP nerve fibres related to blood supply within human Schneiderian membrane of the maxillary sinus (MS).Material and methodsIn this study, the MS from Japanese cadavers was examined by whole-mount immunohistochemistry. Human male cadavers (ranging in age from 80 to 90 years) were used in this study.ResultsSP- and CGRP-positive fibres were found around large vessels of the medialis superior alveolar branches and also within the floor region of the MS. The floor region of the MS was composed of complex branches of these fibres.ConclusionOur results give useful information for surgical sinus floor elevation in this region of the MS. These anatomical features may assist in the execution of a successful surgical procedure.     

Epidemiology of hereditary sensory and autonomic neuropathy type IV and V in Japan

Hereditary sensory and autonomic neuropathy (HASN) refers to a group of rare congenital disorders characterized by loss of pain sensation and other sensory or autonomic abnormalities. Among them, a relatively large proportion of patients with HSAN type IV, which is accompanied by anhidrosis and intellectual disability, are reported from Israel and Japan. HSAN type V, with normal sweating and mental development, is rarely reported in Japan. In 2009, we founded a research group for congenital insensitivity to pain and performed the first epidemiological survey of HSAN types IV and V in Japan. Questionnaires were sent to a total of 3,488 certified training institutions of five nationwide medical societies comprising pediatricians, neurologists, orthopedic surgeons, and dentists. Answers were obtained from 1,610 institutions, and 192 HSAN patients (152 with type IV and 28 with type V) were reported from 105 institutions. After excluding duplicated patients, we identified a total of 62 current, 36 past, and five deceased patients for HSAN‐IV, and a total of 14 current, 13 past, and 0 deceased patients for HSAN‐V. Using these figures, we estimated that the number of Japanese patients with HSAN types IV and V as 130–210 and 30–60 patients, respectively. We identified no gender differences, and patients with a family history of the disorder were limited to affected siblings in both conditions. Most patients with HSAN‐IV were 5–40 years of age, whereas half of the patients with HSAN‐V were 40 years or older. © 2013 Wiley Periodicals, Inc.     

Multiple calcifications within the parotid gland of patients with Sjögren's syndrome

PurposeThe purpose of this study was to investigate computed tomography (CT) and clinical features relating to calcifications within the parotid gland of patients with Sjögren's syndrome (SS).MethodsData from 30 patients with SS who had been examined by CT were extracted from our radiological information database accumulated from 2001 to 2011, and their CT images were reread carefully. Of these patients, 14 (all female; age range 20–95 years; mean age 61.4 years) with calcifications within the parotid gland were retrospectively investigated with CT findings. The relationship between calcification occurrence and clinical symptoms including parotid swelling and/or saliva colic was investigated. The degree of destruction of the parotid gland on CT images was also evaluated.ResultsAll calcifications of 14 patients were located within the parotid gland, not in the parotid duct. CT images of all calcifications showed small and regular round shapes. Multiple occurrences of calcifications were recognized in 10 patients, and a solitary occurrence was seen in 4 patients. Seven patients had bilateral calcifications. There was little relationship between the occurrence of calcifications and clinical symptoms, and the severity of destruction of the parotid gland.ConclusionThe presented CT and clinical features would be peculiar to SS because too many patients lacked the typical features of sialoliths within the parotid gland.     

A large-scale nationwide multicenter prospective observational study of triple therapy using rabeprazole,amoxicillin, and clarithromycin for <Emphasis Type="Italic">Helicobacter pylori</Emphasis> eradication in Japan

Background  

In recent years in Japan, the rate of clarithromycin (CAM) resistance in Helicobacter pylori has risen to around 30%, and the eradication rate with triple therapy [proton pump inhibitor + amoxicillin (AMPC) + CAM] has been trending downward to around 70%. In 2007, rabeprazole (RPZ)-based triple therapy (RPZ + AMPC + CAM: RAC therapy) was approved in Japan, and a large-scale nationwide study was therefore initiated to evaluate the efficacy and safety of RAC therapy in clinical practice.