Use of a Paracorporeal Pneumatic Ventricular Assist Device for Postoperative Cardiogenic Shock in Two Children with Complex Cardiac Lesions

Pneumatic ventricular assist device (VAD) was utilized for cardiogenic shock after intracardiac operation in two children with complex cardiac anomalies based with single ventricle. In the first case (a 10-year-old), after a modified Fontan operation, VAD was placed between the functional left atrium and ascending aorta, serving as a "artificial single ventricle" with neither pumping chamber nor artificial support in the right side of the heart. The systemic circulation was maintained by keeping relatively high central venous pressure. In another child (a 3-year-old) who underwent repair of incompetent atrioventricular valve leaving intracardiac lesions, VAD was placed between the common atrium and ascending aorta, serving as a pump for both pulmonary and systemic circulation with regulation of pulmonary blood flow through an aortopulmonary Gore-Tex shunt. The circulatory assist with VAD was utilized for 5 and 6 days, respectively. Although weaning from the device was not feasible in both patients because of the pulmonary dysfunction, these experience showed the possible use of VAD for cardiogenic shock after surgery in patients with complex cardiac anomalies.     

Thrombomodulin accelerates activated protein C production and inhibits thrombin generation in the plasma of disseminated intravascular coagulation patients.

Thrombomodulin (TM) has been under development as a medicine for disseminated intravascular coagulation (DIC), and is expected to exhibit strong anticoagulant activity by inhibiting thrombin generation via the acceleration of protein C activation. In the present study, we examined the pharmacological action of TM in plasma obtained from DIC patients. TM was found to inhibit thrombin generation and accelerate activated protein C (APC) production at 0.3-30 TM units/ml in plasma obtained from DIC patients irrespective of their underlying disorders. In addition, there was a positive correlation between the inhibition of thrombin generation and the amount of APC produced. Thrombin generation was inhibited by over 50% when the plasma level of APC was increased by more than 0.2 microg/ml. These results indicate that TM inhibits thrombin generation in plasma obtained from DIC patients by accelerating APC production. Moreover, the results imply that the thrombin generation test may be a good method to speculate the efficacy of TM on every patient before the administration of TM.     

Color Doppler Imaging of the orbital vessels

In ophthalmologic ultrasonography, Color Doppler Imaging (CDI) is a valuable method for detecting hemodynamic information in the central vessels of the retrobulb (ophthalmic artery, central retinal artery and internal carotid artery, etc.) and complementing the diagnosis of eye and eyeground view. Especially in diabetics, if orbital peripheral vascular resistance goes up with progress of diabetic retinopathy, the ophthalmic artery flow velocity wave form undergoes remarkable change, and the ratio of systolic mean velocity to diastolic mean velocity (mean S/D ratio) increases. On the other hand, if carotid obstruction and carotid advanced stenosis arise in sphagitides by the progress of macroangiopathy, the ophthalmic artery becomes the collateral pathway. Then, the flow directional reversal responsible for the collateral pathway is recognized and enters cerebral circulation and, as a result, the ophthalmic artery causes a fall in retinal circulation. As mentioned above, CDI in the ophthalmologic field plays a useful role not only in eyeground management, but in elucidation of the mechanism of ocular ischemic syndrome.     

Time-dependent effect of glutamate on long-term potentiation in the suprachiasmatic nucleus of rats

The effect of glutamate on optic nerve stimulation-evoked field potentials in rat suprachiasmatic nucleus (SCN) was examined in vitro. Glutamate application for 20 min induced long-term potentiation (LTP) of the field potentials in the SCN at nighttime, whereas that induced a weak LTP at daytime. On the other hand, application for 40 min induced LTP in the SCN during the daytime, whereas it induced a weak one at nighttime. These results indicate that the effect of glutamate is dependent on the application time and that the effect is influenced by the duration of glutamate exposure.     

A 7-year-old boy with mycoplasmal infection requiring extracorporeal membrane oxygenation

A 7-year-old boy with Down syndrome developed severe acute respiratory distress syndrome after a respiratory infection with Mycoplasma pneumoniae with an unusually high agglutination titre (1:10240). Initially, mechanical ventilation and nitric oxide inhalation were used, but these did not improve the alveolar-arterial oxygen gradient. Extracorporeal membrane oxygenation for 152 h improved the lung condition. CONCLUSION: our case suggests that Mycoplasma pneumoniae should be considered as an aetiological agent in acute respiratory distress syndrome. Extracorporeal membrane oxygenation might have a valuable role in the management.     

Effect of prophylaxis against myocosis in patients with hematological malignancy disease: efficacy of dosage of itraconazole

Prophylactic effect of itraconazole (ITCZ) in mycosis associated with hematological malignancy was studied. In a total of 12 patients of hematological malignancy admitted to Hokkaido University Hospital from April, 2001 to March, 2002, six patients received 100 mg per day of ITCZ and the other six received 200 mg per day of ITCZ. ITCZ was administrated from the starting of chemotherapy, and from the time point capable of oral administration in bone marrow transplantation patients. ITCZ administration was finished based on docter's judgement. As the results of this study, three cases with 100 mg per day of ITCZ had mycosis, but none with 200 mg per day of this drug had it. Mild itching associated with ITCZ was found only one case. In conclusion, we suggest that ITCZ is effective and safe drug in terms of prophylaxis of mycosis.     

Relationship between identified patient (IP) with alcoholic problems and familial factors: in reference to family function, co-dependence, family group and self-help group participation]

In 1994, a survey was conducted to 105 wives of alcoholics (identified patient: IP) about levels of their family adaptability, cohesion, co-dependence, family group and self-help group participation. In 1995, a follow-up survey was conducted to the same wives. 87 wives responded to the follow-up questionnaire. 17 responses were excluded due to too many missing responses. Statistical analyses were therefore conducted to the remaining 70 subjects. The following results were found. 1) Balanced as opposed to extreme levels of cohesion were associated with abstinence. 2) Family system changes on cohesion and/or adaptability dimensions were associated with abstinence. 3) Wife's over-involvement with drinking husband somewhat appeared to be related to continuation of drinking. As for participation in family group or self-help groups, there was no significant difference between abstinence and drinking groups.     

Lymphoid tumor in the orbit: malignant or benign? MRI, histomorphological and molecular genetic analysis of eight cases

Differentiation between benign and malignant lymphoid infiltrates of the conjunctiva and the orbit is difficult even on the basis of histopathological appearance. We describe eight cases with low-grade malignant lymphoma, mucosa-associated lesion tissue (MALT) lymphoma. Laboratory analysis was done using microscopy, immunophenotyping and gene rearrangement using the Southern blot technique. DNA-rearrangement analysis allows a very precise determination of the benign and malignant lymphoid infiltrates of the ocular region. Our MRI findings show that these tumors can also generally be distinguished by their signal intensity on T2-weighted images. These findings might explain the favorable prognosis for MALT lymphoma of the conjunctiva and the orbit, and the absence of any recurrence in follow-ups ranging from 6 months to 9 years.     

Hemostatic molecular markers before the onset of disseminated intravascular coagulation

We retrospectively measured various hemostatic markers in 240 patients with disseminated intravascular coagulation (DIC) before the onset of DIC and in 110 non-DIC patients, and examined their usefulness for the diagnosis of pre-DIC. Changes in prothrombin time ratio and fibrinogen levels were not significant before the onset of DIC. The plasma levels of fibrinogen and fibrin degradation products before the onset of DIC were increased and the platelet count was gradually reduced in nonleukemic patients; these changes were already significant in the non-DIC state. The plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were increased before the onset of DIC. In leukemic patients, the plasma levels of sFM on day 5, those of TAT on day 3, and D-dimer on day 1, were significantly increased before the onset of DIC. The levels of most hemostatic markers 7 days before the onset of DIC were not different from those observed in the non-DIC state. In nonleukemic patients, only D-dimer, sFM, and TAT levels were significantly increased 7 days before the onset of DIC compared with values in the non-DIC state. The positive rate of hemostatic markers for the diagnosis of DIC, TAT, and PPIC were high during the pre-DIC and non-DIC groups. The plasma levels of sFM and D-dimer were low in non-DIC and increased gradually during the pre-DIC state. These findings suggest that hemostatic molecular markers such as sFM, D-dimer, and TAT are useful for the diagnosis of pre-DIC, although their cutoff values were different among various diseases.