Search

We report a rare case of pediatric clinically mild encephalitis/encephalopathy with a reversible splenial lesion(MERS)associated with transient ischemic attack(TIA)-like symptoms. A 13-year-old boy who presented with transient left hemiparesis and dysarthria was transferred to our hospital. He had experienced similar symptoms at the age of nine years and was diagnosed with MERS type 2 due to the typical clinical course and MR imaging findings. His elder brother showed a similar clinical history at the age of eight years. DW-MR images on admission revealed high signal intensity areas in the splenium of the corpus callosum and deep white matter. The territories were depicted as low intensity on apparent diffusion coefficient maps and slightly high intensity on T2-weighted images. Recurrence of MERS type 2 was considered because the symptoms of the patient disappeared within several hours and the abnormal signal intensities markedly decreased on the follow-up DWI performed eight days after initial MR imaging. The abnormal MR imaging findings completely disappeared after five weeks. After discharge, the patient experienced eight TIA-like episodes with a similar clinical course and MR imaging findings over a period of six years. MERS associated with TIA-like episodes is extremely rare, especially MERS associated with recurrent episodes in multiple phases over a long period, as seen in the present case. In addition, the findings in the last two MR imaging scans involving the internal capsule, thalamus, and midbrain were highly unusual and maybe considered to be indicative of an advanced form of MERS type 2, as reported in other familial cases.

Here we describe a case of an 18-year-old boy who exhibited abnormal pulmonary parenchyma supplied by an aberrant artery from the descending aorta in the right lower lobe of the lung and a cystic tumor measuring 34×26×54 mm in the right upper mediastinum. Video-assisted thoracic surgery for resection of the 2 lesions showed that they were independent of each other. Final diagnosis of an intralobar pulmonary sequestration in the right lower lobe and a bronchogenic cyst in the upper mediastinum was made. In some reports, 2 lesions were described to be in close proximity to and connected with each other, but the present case is unique in that the 2 lesions were completely independent of each other.

This study evaluated the correlation between the acute course and prognosis of patients with acute myocardial infarction complicated by heart failure. Heart failure was defined as a mean pulmonary capillary wedge pressure equal to or greater than 20 mmHg with radiographic evidence of pulmonary congestion during hospitalization in the coronary care unit. A total of 77 heart failure patients underwent primary percutaneous transluminal coronary angioplasty or thrombolysis. Twelve patients who died within the first 3 days (group I) had a higher incidence of unsuccessful reperfusion (50 vs 19%, p < 0.05) and cardiogenic shock (64 vs 4%, p < 0.01), compared with the 65 patients who survived at least the initial 4 days (group II). These 65 patients were classified into three subgroups according to the course of heart failure: early regression type (group IIA, n = 38); prolonged type (group IIB, n = 18); delayed-onset type (group IIC, n = 9). Patients in group IIB had a higher incidence of multivessel disease than group IIA. Patients in group IIC had a higher incidence of unsuccessful reperfusion. Cardiac index in group IIB was lower than in group IIA (2.50 +/- 0.70 vs 1.91 +/- 0.39 l/min/m2). Changes in left ventricular ejection fraction were 4.1 +/- 9.2% in group IIA, -6.6 +/- 16.8% in group IIB, and 0.9 +/- 7.3% in group IIC. The hospital mortality rate was 0% in group IIA, 11% in group IIB, and 33% in group IIC, the reinfarction rate was 0, 17 and 22%, and sustained arterial patency was demonstrated in 81, 62 and 43%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of Saber-sheath type tracheo-bronchomalacia complicating bronchial asthma was treated by external fixation of Marlex mesh, and good results were obtained. The patient was a 43-year-old male who had been treated for bronchial asthma for over nearly 20 years. Since 4 years ago, dyspnea and a feeling of obstruction of the larynx developed and gradually aggravated. He lost consciousness twice and was hospitalized on an emergency basis. Pulmonary function tests performed during remission of asthma attacks revealed an obstructive disorder: FEV1.0% was 30.5% and peak flow was 4.11 L/sec. Bronchoscopy and tracheo-bronchography revealed Saber-sheath type tracheo-bronchomalacia in the trachea and the right main bronchus. The severity of the obstruction was, in terms of Johnson's classification, II. for the trachea and I. for the right main bronchus. In accordance with the method reported by Hanawa and Ikeda, external fixation was applied to the trachea and the right main bronchus; that is, Marlex mesh was applied around to the trachea and the right main bronchus, and additional Lyodura was applied over the Marlex mesh. The postoperative course was satisfactory. Both FEV1.0% and the peak flow improved, and constriction of the trachea and the right main bronchus at the time of coughing was also reduced.

Aortic valve replacement was performed in 2 patients with severe aortic stenosis. They showed severe calcified valve and narrow aortic annulus. The aortic annulus was enlarged to 22 mm and 23 mm in diameter in each patient by the technique of Nicks. Then aortic valve replacement was performed with Medtronic-Hall valve (#21) which is supposed to get larger valve area than Björk-Shiley valve. They had good operative course except a complication of complete AV block in the first patient. In this patient a DDD pacemaker was implanted 19 days after operation. Cardiac catheterization was performed 11 or 12 months after operation and good hemodynamics was obtained in both patients. The aortic mean pressure gradient was 6 and 5 mmHg at rest, and 9 and 13 mmHg during exercise on bicycle ergometer in each patient. The aortic valve area was 1.7 and 1.9 cm2, respectively. Body surface area in these patients was 1.29 and 1.36 m2. We concluded that in the small patients we could get a good result with Medtronic Hall valve (#21).

Invasion of the neoplasma to the upper airway tract is the life threatening factor. We experienced a 74-year-old female with thyroid carcinoma invading the trachea, for whom radical resection was infeasible. So for the palliation of airway obstruction we inserted the silicone rubber T-tube stent from 0.5 cm above the vocal cord to 2 cm before the carina after endotracheal tumor resection with Nd-YAG laser. As the result, she has led an active life for the last 6 months after the operation. We consider that the T-tube stent is effective tool in the management of airway obstruction for the slow growing neoplasma.

We experienced a case of late-onset myasthenia gravis associated with Hashimoto's disease. A 74-year-old female with chief complaints of extremities acratia and hypohidrosis was diagnosed as having myasthenia gravis by the Tensilon test. In addition severe hypothyroidism was noted, and histological examination of a thyroid biopsy revealed Hashimoto's thyroiditis. Extended thymectomy was carried out, and the postoperative course was uneventful due to administration of an anti-ChE drug and a thyroid hormone. This case is extremely rare because only 10 patients with late-onset (over 70 years old) myasthenia gravis have been reported in the literature in Japan, and only three of them were associated with Hashimoto's disease. It was suggested that, in cases of myasthenia gravis in elderly patients, we should take into consideration radical therapy including thymectomy as a positive approach to treatment.

A 56-year-old man, a heavy cigarette smoker, had his left upper lobe resected for lung cancer. Seventeen months later, he was diagnosed as early laryngeal cancer by bronchofiberscopy. In this case, postoperative follow-up study with septum cytology was extremely effective. He underwent radiation therapy for the laryngeal cancer. Today, three and a half years later, no signs or symptoms of any cancer can be found. Cases of preceding lung cancer in multiple primary cancer patients having lung and laryngeal cancer are very rare in the literature. All of them have been heavy cigarette smokers and majority of them men.