Chronically Recurrent and Disseminated Tinea Faciei/Corporis—Autoinoculation from Asymptomatic Tinea Capitis Carriage

Abstract: We report clinical findings in a 12‐year‐old girl with long‐term recurrent and disseminated multiple eruptions of tinea faciei and tinea corporis, which persisted for 10 years. Mycological examination revealed the dermatophyte Trichophyton tonsurans in both scale samples from the body lesions and in brushing samples from her asymptomatic scalp, suggesting that she was an asymptomatic dermatophyte carrier on the scalp, and autoinoculation of the dermatophyte was responsible for the recurrent and disseminated tinea faciei/corporis.     

Injection Sclerotherapy for Recurrent Esophageal Varices after Surgical Procedures

Abstract: Thirteen patients, who had recurrent esophageal varices after esophageal transection or esophagoproximal gastrectomy were treated by endoscopic injection sclerotherapy. Four patients successfully underwent emergency sclerotherapy to control active variceal hemorrhaging. Three of these patients and the remaining nine patients (including six rebleeding patients who were conservatively treated) underwent elective sclerotherapy. None of the patients had variceal rebleeding in the follow-up study with sclerotherapies. Only one patient with recurrent varices did not undergo any additional sclerotherapy following emergency treatment. In this study, no deaths occured nor any major complications. Minor complications such as low grade fever and chest pain were observed, but they were transient and disappeared within 2 or 3 days without specific treatments. It is concluded that endoscopic injection sclerotherapy is considered to be the most effective procedure for recurrent varice following surgery.     

Sleep disorder in children with autism

Abstract Eighty-eight children with autism, living in a suburb of Tokyo, were examined by questionnaire from 21 July to 31 August. Experienced sleep disorders were observed in 56 children; 44 of whom had sleep disorders before 3 years old. The average age when sleep disorders were seen to have stopped was 5 years old. The most common problem was difficulty falling sleep ( n = 23), followed by frequent awakening during sleep time ( n = 19), then early morning awakening ( n = 11). Bed-wetting was observed in 22 children.     

Biopharmaceutics: Enhanced Absorption of Calcium after Oral Administration of Maltitol in the Rat Intestine

The enhancing effects of maltitol (α-D-glucopyranosyl-1,4-sorbitol) on absorption of calcium by the rat intestine have been studied by use of [⁴⁵Ca]CaCl₂ in-vivo. After intragastric administration of [⁴⁵Ca]CaCl₂ solution with maltitol, plasma ⁴⁵Ca concentration remained at the maximum level for more than 80 min, whereas for animals given [⁴⁵Ca]CaCl₂ solution without maltitol, plasma ⁴⁵Ca concentration declined sharply after the peak. Determination of ⁴⁵Ca radioactivity remaining in the various segments of the gastrointestinal tract revealed that administration of maltitol elicited slower gastric emptying and slower intestinal transit, resulting in extensive ⁴⁵Ca distribution along the small intestine throughout the experimental period. The luminal contents of the small intestine were significantly higher in rats given maltitol than in the control group. These results suggest that the enhancing action of maltitol on intestinal calcium absorption could be attributed to reduced gastrointestinal calcium transit and increased luminal fluid content, presumably because of the osmotic activity of maltitol; this would not only accelerate the dissolution of calcium into the increased luminal contents, but also enable a larger area of the small intestine to absorb calcium for a longer period of time.     

Injection Sclerotherapy for Esophageal Varices Associated with Hepatocellular Carcinoma and Liver Cirrhosis

Survival period, causes of death and variceal rebleeding in 20 patients with esophageal varices associated with hepatocellular carcinoma and liver cirrhosis were analyzed to evaluate the effectiveness of injection sclerotherapy. The first injection sclerotherapy successfully stopped active variceal bleeding in all seven emergency cases. These were followed up as elective cases later on. The remaining 13 patients, who had a history of variceal bleeding, were treated as elective cases from the beginning. Endoscopic evaluation of the varices was performed at intervals of six months to one year, after the first sclerotherapy, and recurrence was treated by elective sclerotherapy. 85% of the patients died within one year. Three out of 20 cases were still alive until this study was performed. But, whereas 17 patients died mainly due to hepatic failure and hepatocellular carcinoma, only one patient died due to variceal rebleeding. No deaths were observed to have been directly due to sclerotherapy or its complications. Hence we think that injection sclerotherapy should be considered one of the treatments for esophageal varices in patients with hepatocellular carcinoma and liver cirrhosis.     

Endoscopic Sclerotherapy for Esophageal Varices After Surgical Procedures for Congenital Biliary Atresia

Abstract: The effectiveness of injection sclerotherapy for esophageal varices due to congenital biliary atresia has not yet been established. Sclerotherapy was performed to treat esophageal varices in four children with variceal bleeding who had received a hepatic portoenterostomy for congenital biliary atresia. Ethanolamine oleate was mixed with a contrast medium for the varicealography in order to determine the flow of the sclerosant by fluoroscopy. Varicealography which was conducted during the injection allowed us to stop the procedure so that mixture would fill up the varix and its feeders but would not enter the systemic circulation. Between 0.5 ml to 2.0 ml of sclerosant was injected at the variceal puncture. There was one case bleeding from the esophageal ulcer. However, it was resolved by conservative treatment. All four children experienced no rebleeding after the therapy. Therefore, injection sclerotherapy using varicealography with sclerosant–contrast medium mixture is recommended for children who develop esophageal varices after surgical procedures for congenital biliary atresia.     

Retroperitoneal perforation of a pancreatic cyst during endoscopic retrograde pancreatography

A 70‐year‐old man was admitted to Ueno Municipal Hospital, Ueno, Japan, for evaluation of abdominal distension. Computed tomography showed a 1 × 1 cm cyst at the pancreas tail. Endoscopic retrograde pancreatography (ERP) showed a normal pancreatic duct after the first gentle injection and an enhanced cyst at the pancreas tail. Extravasation of the contrast medium occurred from the pancreatic duct to the superior‐dorsal extrapancreas at the same time of the next low‐pressure manual injection. Computed tomography showed extravasation of the contrast medium from the pancreas cyst to the retroperitoneal space after ERP. It was considered that the cyst wall weakness, in addition to slight elevated pancreatic duct pressure, caused the disruption of the cyst wall.     

Reversal of Portosystemic Encephalopathy after Endoscopic Embolization of Recurrent Gastroesophageal Varices

Chronic portosystemic encephalopathy (CPSE) due to a shunt via gastroesophageal varices is uncommon. We were able to control a case of CPSE due to recurrent gastroesophageal varices using endoscopic embolization (EE). A 68-year-old man presented at our hospital in a confused, apathetic and tremulous state. He had undergone devascularization, proximal gastric transection and splenectomy for esopha-geal varices due to liver cirrhosis 16 years previously. The patient had hyperammone-mia (228 µg/dl), and endoscopic examination revealed nodular cardiac varices and large recurrent esophageal varices. Superior mesenteric arterial portography revealed that a large volume of superior mesenteric venous blood drained into the cardiac and esophageal varices through the remnant left gastric vein. The plasma ammonia level in the esophageal varices taken at the time of EE was 419 pg/dl, which was a much higher level than that of peripheral vessels, the superior vena cava and azygos vein, and suggested that the encephalopathy was due to the portosystemic shunt via the gastroesophageal varices. EE was performed using 5% ethanolamine oleate with iopamidol under fluoroscopy. The esophageal and cardiac varices were successfully embolized, the CPSE disappeared, and the plasma ammonia level decreased to 27 pg/dl. No complications were observed, and the patient was discharged on day 37 after EE. We conclude that EE is an effective and safe treatment for CPSE due to gastroesophageal varices.     

Endoscopic Sclerotherapy for Esophageal Varices after Renal Transplantation: Report of One Autopsy Case

Abstract: Endoscopic sclerotherapy has been used to manage esophageal varices. Severe complications resulting from this therapy including renal dysfunction have been reported. Therefore, particular caution must be taken with patients who have serious renal damage. Sclerotherapy was performed for esophagogastric varices in a patient that had received a kidney transplant following chronic renal dysfunction. Ethanolamine oleate was used as the sclerosant, and contained a contrast medium for varicealography in order that the flow of the sclerosant be monitored by fluoroscopy. Varicography during the injection allowed us to stop injection into the varices and into the irregular passageways of the feeders to the varices before the agent entered the systemic circulation. There were no complications during therapy. The patient died due to respiratory failure 41 months after the first treatment. Macroscopic findings of the autopsied specimens showed no esophagogastric varices and microscopic findings showed organized varices with recanalization into the submucosal layer of the esophagogastric lesions. Injection sclerotherapy using varicography with sclerosant-contrast medium mixture allowed treatment of this patient without incurring renal dysfunction.