Spontaneous acute subdural haematoma and intracerebral haemorrhage in patient with HELLP syndrome: case report

HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome can result in a fatal intracranial haemorrhage during the perinatal period. We report treatment of a 32-year-old primigravida who fell into a deep coma during labour with fetal distress, complicated by a spontaneous acute subdural haematoma and intracerebral haemorrhage. Simultaneous emergency operations, evacuation of the acute subdural haematoma and a caesarean section, were performed, during which a diagnosis of HELLP syndrome with disseminated intravascular coagulation was made. Both mother and infant recovered, though hemiparesis persisted in the mother. Patients with HELLP syndrome should be managed as high-risk, which requires an excellent working relationship of the physicians involved. Prompt recognition of intracranial haemorrhagic complications and neurosurgical intervention are particularly important.

Population of follicles and luteal structures during the oestrous cycle of mares detected by three-dimensional internal structure microscopy

The structure of the equine ovary is different from that of other mammals in its extremely large size, the presence of ovarian fossa and the inverted location of its cortex and medulla. A three-dimensional internal structure microscopy (3D-ISM), which consists of a computer-controlled slicer, a CCD camera, a laser disc recorder and a PC, is very useful for the observation of the internal structures in equine ovaries. In addition, the three-dimensional images of follicles and corpus luteum (CL) reconstructed by the segmentation technique can clarify the spatial arrangement in the equine ovary. In this study, to understand the changes in the ovarian internal structures of the mare during the oestrous cycle, the size and numbers of follicles and luteal structures were analysed by 3D-ISM in addition to the concentrations of progesterone (P(4)) and oestradiol-17beta. As a result, many small follicles (<10 mm in diameter) were detected. It was recognized that the luteal structures were distinguished into three types, such as the corpus haemorragicum (CH), which is formed by blood elements at the cavity after ovulation, CL and corpus albican (CA). There were some CHs and CL in the group, which had the concentration of P(4) > 1 ng/ml. CHs were also observed in the group, which had low level of P(4) (P(4) < 1 ng/ml). CAs were found regardless of the P(4) level. In conclusion, 3D-ISM enabled the internal observation of the ovarian structures in detail, and estimation of the stage of the ovarian cycle with complementary physiological information. The findings by 3D-ISM provide basic information for clinical applications.

A pharmacogenetic UGT1A1 dose-escalation study for recurrent and refractory gynecologic cancer patients treated with combination therapy of irinotecan and cisplatin

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Background: In addition to polymorphisms of UGT1A1*28, UGT1A1*6 has been recognized as a risk factor for severe irinotecal-related toxicities. We have conducted an UGT1A1 genotype-based dose-escalation study for recurrent and refractory gynecologic cancer patients (pts) treated with combination with irinotecan and cisplatin (CPT-P). Methods: Pts eligible for this study had histologically confirmed uterine cancer or ovarian cancer, who received CPT-P; a course of therapy consisting of 40–80 mg/m2 of irinotecan on days 1, 8, and 15 and 60 mg/m2 of cisplatin on day 1, q4weeks. Polymorphisms of UGT1A1*28 and *6 were analyzed and the pts were categorized into three groups (wild-type, hetoro-type, and homo-type). Pharmacokinetics of CPT-11, SN-38, SN-38 glucuronide (SN-38G), and platinums were analyzed according to the UGT1A1 genotyping. Results: During August 2008 and December 2008, 17 pts were enrolled in this study; 12 ovarian cancers and 5 uterine cancers. Genotypes of UGT1A1 were wild in 9 pts (53%), *28 in 4 pts (24%), *6 in 3 pts (18%), *6/*6 in 1 pt (6%). At the starting doses of irinotecan (60 mg/m2 for wild-type and 40 mg/m2 for hetero-/homo-type), dose limiting toxicities were observed in two of six wild-type cases and one of six hetero-type cases. Pharmacokinetic analyses revealed hetero-type cases were associated with lower area under time-concentartion curve (AUC) SN-38G to SN-38 (AUCSN-38G/AUCSN-38) compared with wild-type cases (p = 0.02), however, there was no significant difference of AUCSN-38at the starting dose. Additionally, AUC of platinum was slightly higher in hetero-type cases in comparison with wild-type cases (p = 0.04). Pharmacokinetics of the drugs were similar between *28 and *6 cases. Conclusions: The present study indicated clinical significance of UGT1A1 genotyping upon pharmcokinetics of not only SN-38G/SN-38 but also platinum. In addition to UGT1A1*28, UGT1A1*6 was a key candidate to influence the pharmacokinetics of CPT-P regimen in gynecologic cancer patients.

No significant financial relationships to disclose.

Clinical significance of UDP-glucuronosyltransferase 1A1*6 for toxicities of combination chemotherapy with irinotecan and cisplatin in gynecologic cancers: a prospective multi-institutional study

BACKGROUND

To investigate the effects of UDP-glucuronosyltransferase 1A1 (UGT1A1) *28, *6 and *27 in patients with gynecologic cancer who received chemotherapy with irinotecan and cisplatin.

METHODS

Patients eligible for this study had cervical or ovarian cancer treated with chemotherapy; a course of the regimen consisted of 60 mg/m(2) of irinotecan on days 1, 8 and 15, and 60 mg/m(2) of cisplatin on day 1 every 4 weeks. UGT1A1 polymorphisms and toxicities were analyzed.

RESULTS

From March 2007 to December 2007, 30 Japanese patients were enrolled; 24 ovarian carcinoma patients and 6 cervical cancer patients. The following genotypes of UGT1A1 were found: wild type in 17 patients (57%), *28 in 4 patients (13%), *6 in 8 patients (27%), *28*6 in 1 case (3%) and no case of *27 (0%). Grade 3/4 neutropenia, thrombocytopenia and diarrhea were significantly more frequent in *6 patients compared with wild-type patients. Also, in *6 patients irinotecan administration on days 8 or 15 was significantly more often omitted due to toxicities. In patients with *28 or *28*6, side effects were similar to those in patients with *6.

CONCLUSION

In addition to UGT1A1*28, UGT1A1*6 might also be a key candidate to determine the dose of combination chemotherapy with irinotecan and cisplatin.

Stable confinement of nanosecond laser pulse in an enhancement cavity

We present a technique that enhances the intensity of a nanosecond laser pulse by confining it in an enhancement cavity. The point of the technique is that a weak continuous-wave laser radiation, locked to the enhancement cavity, is injected into a nanosecond injection-locked pulsed laser as a seed. This leads to a stable confinement of the nanosecond pulse in the enhancement cavity. It is demonstrated that the pulsed intensity is enhanced by a factor of 120 for a 40-ns pulse, consistent with the theoretical prediction.

Joint loading modality: its application to bone formation and fracture healing

Sports-related injuries such as impact and stress fractures often require a rehabilitation programme to stimulate bone formation and accelerate fracture healing. This review introduces a recently developed joint loading modality and evaluates its potential applications to bone formation and fracture healing in post-injury rehabilitation. Bone is a dynamic tissue whose structure is constantly altered in response to its mechanical environments. Indeed, many loading modalities can influence the bone remodelling process. The joint loading modality is, however, able to enhance anabolic responses and accelerate wound healing without inducing significant in situ strain at the site of bone formation or fracture healing. This review highlights the unique features of this loading modality and discusses its potential underlying mechanisms as well as possible clinical applications.

Fine Structure of Detached Coils Observed by Micro-CT

SUMMARY

Detached GDC was observed by high resolutional industrial microCT, whose resolution was higher than 0.1 mm. Unexpected destruction of the coils (kinking) was detected and unraveling also clearly visualized. Much higher resolution can improve safe and effectivity of GDC procedure.

Experimental studies on the bone metabolism of male rats chronically exposed to cadmium intoxication using dual-energy X-ray absorptiometry

Cadmium (Cd) has been identified as the etiologic agent of itai-itai disease. The purpose of this study was to investigate whether chronic Cd exposure affects bone metabolism in a male rat model and to estimate the bone mineral density (BMD) differences in lumbar and femoral bone because of Cd exposure. Six-week-old male Hos Donryu rats were used in this experiment. Cadmium was administered at a dose of 200 ppm to rats in the diet to produce experimental chronic Cd poisoning. Bone mineral density was measured using dual-energy X-ray absorptiometry (DEXA) with a high-resolution scan collimator (0.25 mm diameter) (Hologic QDR-2000). The Cd content in renal tissue reached a critical concentration of 128.42 ± 14.38 μg/g 10 months after the administration of the element (Table 3). The average blood urea nitrogen (BUN) value was increased throughout the period of the experiment, and the serum creatinine value of the experimental group showed an increase after 2 months of Cd administration (0.46 ± 0.09 mg/dL). The concentration of urinary calcium changed in the experimental group after exposure to Cd for 12 months (15.4 ± 0.13 mg/dL). DEXA showed a greater reduction in the bone mineral density of the 5th vertebral body (L5) in rats that had ingested Cd for 4 months (0.359 ± 0.013 g/cm2) than in control rats (0.372 ± 0.012 g/cm2, P < 0.01). On the contrary, the difference in bone mineral content between rats ingesting Cd for 6–8 months and control rats was not significant. However, significant reductions in bone mineral content were again noted in rats that had ingested Cd for 12 months (0.339 ± 0.023 g/cm2) compared with the control group (0.385 ± 0.012 g/cm2, P < 0.01). The bone mineral density of the right femoral bone in control rats was 0.328 ± 0.018 g/cm2 and that in experimental rats was 0.306 ± 0.012 g/cm2, and a meaningful difference was recognized ( P < 0.05). Histological examination of the rats exposed to Cd for 12 months showed that the 5th lumbar vertebral body (L5) exhibited osteomalacia. The results of our studies show that Cd stimulated a loss of bone mineral at an early stage to a great extent in male rats. In the examination of male rats, bone injury and renal functional disorder were encountered simultaneously. This study suggested that osteomalacia was induced by a direct action of Cd on the bone through abnormal calcium homeostasis at an early stage in male rats.

Neutrophil elastase inhibitor improves postoperative clinical courses after thoracic esophagectomy

Sivelestat sodium hydrate is a selective inhibitor of neutrophil elastase (NE), and is effective in acute lung injury associated with systemic inflammatory response syndrome (SIRS). The effect of Sivelestat for postoperative clinical courses after transthoracic esophagectomy was investigated. Consecutive patients with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy between 2003 and 2004 were assigned to the Sivelestat-treated group (n = 18), and those between 1998 and 2003 were assigned to the control group (n = 25). The morbidity rate, duration of postoperative SIRS, mechanical ventilation, and intensive care unit (ICU) stay, and the sum of the sequential organ failure assessment scores at all time points after the operation were compared. Serum NE activities and serum concentrations of TNF-alpha, IL-1beta, IL-6, and high mobility group box chromosomal protein 1 (HMGB1) were measured. Postoperative complications developed in three patients in the control group, and one in the Sivelestat-treated group. The durations of SIRS, mechanical ventilation, and ICU stay were significantly shorter in the Sivelestat-treated group. Even in patients without complications, the durations of mechanical ventilation, and ICU stay were also significantly shorter, and the arterial oxygen pressure/fraction of inspired oxygen ratio at postoperative day 1 was significantly higher in the Sivelestat-treated group. Serum NE activities and serum concentrations of IL-1beta, IL-6, and HMGB1 were significantly suppressed in the Sivelestat-treated group. Postoperative Sivelestat treatment after transthoracic esophagectomy improves the condition of SIRS and postoperative clinical courses, even in patients without complications.

Traumatic cerebral aneurysm associated with a contralateral traumatic carotid cavernous fistula. A case report

SUMMARY

This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury. Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA. Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.

Detection of an isoform of α1 -antitrypsin in serum samples from foals with gastric ulcers

The objective of this study was to find serum indicators of gastric ulcers in foals. By using two-dimensional electrophoresis of serum proteins, three distinct spots were detected in samples from foals with gastric ulcers detected endoscopically. One of them appeared with high frequency and was identified by partial digestion with trypsin and subsequent nano-electrospray ionisation-tandem mass spectrometry (nanoesi-ms/ms) analysis as an alpha(1)-antitrypsin. Western blot analysis, using an antibody against human alpha(1)-antitrypsin, revealed at least two bands, of molecular weight 58 kDa and 55 kDa, in the sera. The 55 kDa band was detected in 44 of 47 serum samples from foals with gastric ulcers, but in only three of 22 serum samples from healthy foals.

Monocarboxylate transporter 1 (MCT1) in the liver of pre-ruminant and adult bovines

This study investigated the distribution and expression of monocarboxylate transporter 1 (MCT1) in the livers of pre-ruminant calves and adult bovines (bulls and cows), using different molecular biological techniques. Reverse transcription-polymerase chain reaction (RT-PCR) verified the presence of mRNA encoding for MCT1 in both pre-ruminant and adult bovine livers. Immunohistochemically, MCT1 was clearly demonstrated on the sinusoidal surfaces of bovine hepatocytes but its expression varied widely between pre-ruminants and adult bovines. In pre-ruminants, a faint hepatocellular expression of MCT1 was observed in a few hepatocytes, whereas an intense immunoreactive staining for MCT1 was shown in the majority of adult bovine hepatocytes. Western blot analysis also confirmed the results of the immunohistochemistry. Quantitative immunoblotting, as estimated by densitometric analysis, showed that the level of MCT1 in the liver of adult bovines was 8-9-fold greater (P<0.01) than that in pre-ruminant calf livers although no significant differences were detected between bulls and cows. The results demonstrated that MCT1 may play a crucial role in the transport of propionate in bovine liver, suggesting that MCT1 expression may be influenced by developmental and metabolic regulations.

Modelling and identification of transcription-factor binding motifs in human chondrogenesis

Chondrogenesis is a dynamical process of cartilage formation involving many transcription factors and transcription-factor binding motifs (TFBMs). Using a series of microarray-derived mRNA profiles for human chondrogenesis, a computational model was built to identify critical TFBMs and model-driven prediction was evaluated experimentally using a promoter competition assay. First, the model was used to approximate the observed mRNA levels using frequencies of potential TFBMs which appeared in the regulatory DNA sequences. Potential TFBMs were chosen from a random population of 5-bp DNA fragments, and the selected genes included chondrocyte specific genes such as type II collagen. Using the Akaike information criterion and the genetic algorithm, six sets of putative TFBMs was chosen from the 5'-end flanking region encompassing 125-, 250-, 500-, and 1000-bp sequences. The minimum model error was obtained in the model with the 500-bp regulatory region. Second, the promoter competition assay was conducted for the selective collagen genes. The assay supported the stimulatory role of a novel TFBM (5'-AGGGG-3') in induction of type II and type III collagens.

Choroidal blood flow in the foveal region in eyes with rhegmatogenous retinal detachment and scleral buckling procedures

AIMS

To investigate changes in choroidal blood flow (ChBF) in the foveal region of the human eye with rhegmatogenous retinal detachment induced by scleral buckling.

METHODS

ChBF was measured in the foveal region using laser Doppler flowmetry in patients with a rhegmatogenous retinal detachment and no macular involvement before and after scleral buckling. The ChBF ratio was evaluated (ChBF of the affected eye to ChBF of the fellow control eye) to minimise individual variations.

RESULTS

Retinal reattachment was confirmed by 2 weeks after scleral buckling in all patients. The ChBF in the foveal region of the affected eyes did not differ from the fellow eyes before scleral buckling. The ChBF ratio significantly (p<0.05) decreased 2 and 4 weeks after scleral buckling compared with that before scleral buckling and returned to baseline 12 weeks after scleral buckling.

CONCLUSIONS

The results suggest that ChBF in the foveal region transiently decreases after scleral buckling and recovers to the baseline level within 12 weeks in patients with a retinal detachment and no macular involvement.