Quantification of changes in metamorphopsia and retinal contraction in eyes with spontaneous separation of idiopathic epiretinal membrane

BACKGROUND

To quantify changes in metamorphopsia and retinal contraction in eyes with idiopathic epiretinal membrane (ERM) before and after a spontaneous separation of ERM.

METHODS

Among 92 eyes of 92 patients with idiopathic ERM who were followed up at our hospital, 5 eyes of 5 patients had experienced a spontaneous separation of ERM during the follow-up period. Patient's metamorphopsia was assessed horizontally and vertically by a metamorphopsia chart developed by our group, M-CHARTS, to obtain the horizontal (MH) and vertical (MV) metamorphopsia scores. Difference in the scores before and after the membrane separation represents change in patient's metamorphopsia. Changes in retinal contraction were also evaluated horizontally and vertically with our original software for fundus image analysis. The difference between M-CHARTS scores and distances of retinal vessel movements with before and after membrane separation were measured.

RESULTS

All five subjects showed a decrease in the retinal contraction. Improved visual acuity was observed in three subjects, and no change was seen in the other two. Four subjects obtained better metamorphopsia scores after the membrane separation, while the other one was not detected with metamorphopsia by M-CHARTS either before or after the separation. In subjects with an improved MV, horizontal retinal movement was seen larger than the vertical movement. Similarly, the subjects with an improved MH indicated a larger vertical retinal movement than the horizontal movement.

CONCLUSIONS

The direction of patient's metamorphopsia closely associated with the direction of retinal contraction before and after a spontaneous separation of ERM.

High-Strength PET Fibers Produced by Conjugated Melt Spinning and Laser Drawing

The mechanical properties of conjugated-spun and laser drawn poly(ethylene terephthalate) (PET) fibers were investigated. The as-spun fibers used for the laser drawing were made by conjugated melt spinning with the copolymer of p-hydroxybenzoicacid and 2-hydroxy-6-naphthoicacid or polystyrene. The PET fibers prepared by conjugated spinning could be laser drawn to higher draw ratios under lower drawing stresses. The drawn fiber could be re-drawn up to a higher total draw ratio. Thus, a PET fiber having a tensile strength of 1.14 N/tex could be produced.

Post-Traumatic Stress Disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake, Kobe, 1995)

The Hanshin-Awaji Earthquake of 1995 and has moved through the various phases into the recovery stage. After the earthquake we conducted two surveys involving approximately 8000 families with pre-school aged children and 466 families with disabled children. Symptoms related to PTSD were found more frequently in the small children whose houses had been severely damaged one year after the earthquake. Although the symptoms decreased, they were still present more frequently in the children and their mothers with severely damaged homes in 1998. Our results show children with intellectual or emotional disabilities displayed many behavioral problems. The physically disabled children required medical resources and specialized support in a structured environment. Both groups voiced the need to set up specialized facilities for people with disabilities. Following the Central Java Earthquake in 2006, we have engaged in "children house" activities in the disaster stricken area in collaboration with Gadjah Mada University. Through this activity, we have been able to share what works in helping children with disabilities and their families. From our experience we have found exchanging of information among the people in the disaster stricken areas helps to reduce the psychological damage of the children and aids in their recovery process.

Associated factors of psychological distress among Japanese pediatricians in supporting the bereaved family who has lost a child

PURPOSE

The psychological distress of pediatricians is a major problem in bereavement care. In this study, the primary factor related to distress is clarified and the future directions of bereavement care provided by pediatricians are examined.

METHOD

A questionnaire was mailed to Japanese pediatricians belonging to the High-risk Infant Follow-up Association and the Society of Child Neurology. Doctors who actually experienced bereavement care were divided into high and low distress groups. We conducted a comparison of the variables for the two groups using a logistic regression analysis, and the primary factor related to psychological distress was analyzed by the odds ratio (OR) and 95% confidence intervals.

RESULTS

The primary factors related to psychological distress were found to be the following 4 items: "gender," "years of experience," "acquisition of coping method," and "feelings of helplessness." In the high distress group, most pediatricians were women, lacked experience, had no coping methods, and felt helplessness.

CONCLUSION

Countermeasures are required for people feeling strong psychological distress. It is necessary to let pediatricians know that their support is helping the bereaved families and to strive to improve their feelings of helplessness. Education for appropriate coping methods and self-care is required for pediatricians desiring to study bereavement care. Consideration is particularly required for doctors who are female and those who lack experience.

[Chronic urinary retention in women caused by primary bladder neck obstruction : report of two cases treated successfully with transurethral resection of bladder neck]

A 60-year-old female was referred to our hospital for the treatment of chronic urinary retention which had compelled her to continue clean intermittent self catheterization (CIC) for several years. After further examination including physical examinations, urodynamic study, cystography, and urethrocystoscopy, she was diagnosed with primary bladder neck obstruction (PBNO). Transurethral resection of the bladder neck (TURBN) was performed to relieve the bladder outlet obstruction and she was free from CIC thereafter. Another 61-year-old female on CIC was also referred to our hospital and diagnosed with PBNO through detailed examinations including urodynamics. She was also successfully relieved of CIC after TURBN. Primary bladder neck obstruction is a condition which can be effectively treated by a less-invasive procedure when properly diagnosed by urodynamic examination. Urologists must keep this rare condition in mind as a possible cause of chronic urinary retention in women.

Treatment of preterm infants with West syndrome: differences due to etiology

BACKGROUND

This study was conducted with a particular focus on preterm infants with West syndrome (WS) to evaluate differences in the first responses to oral medication based on etiology.

METHODS

Medical records of 53 patients with WS, treated at five institutions between 2005 and 2009, were reviewed retrospectively. Patients were divided into six groups based on the time of brain insult, and evaluated for short-term outcomes using oral anti-epileptic agents and synthetic adrenocorticotropic hormone.

RESULTS

The sample consisted of 15, six, 14, two, four, and 12 patients classified, on the basis of apparent time of acquisition of etiology, into the prenatal, term, preterm, postnatal, other, and no identified etiology groups, respectively. Average age of onset in the term group was 3.3 ± 1.0 months, significantly earlier than in the prenatal, preterm, postnatal and no identified etiology groups (P < 0.05). All patients in the term group had experienced seizures before the onset of WS. Only patients in the preterm group had only experienced neonatal seizures, and responded better to treatment. Patients in the preterm group had better responses to treatment, especially oral medication, compared with those in the prenatal and term groups. The prevalence of relapse of seizures in the preterm group (14%) was significantly lower than that in the prenatal group.

CONCLUSIONS

Preterm WS patients responded well to treatment. Distinguishing WS patients on the basis of different etiologies is important for evaluating the effectiveness of treatment.

Hepatitis B virus DNA integration frequently observed in the hepatocellular carcinoma DNA of hepatitis C virus-infected patients

Human hepatitis B virus (HBV) and hepatitis C virus (HCV) are two major etiologic agents of chronic hepatitis, which is closely related to the development of hepatocellular carcinoma (HCC). We investigated the role of HBV coinfection in ongoing HCV-related liver diseases in HCV-infected patients. We found a high prevalence of anti-HBc in anti-HCV-positive/HBsAg-negative HCC patients and also found a close correlation between anti-HBc positivity and integration of HBV DNA into HCC DNA of anti-HCV-positive/HBsAg-negative patients. The present data suggest that integrated HBV DNA may play an important role in the development of HCC in the anti-HCV-positive/HBsAg-negative patients carrying the anti-HBc antibody.

[Clinical utility of measurement of procalcitonin for diagnosis of urosepsis]

We assessed the diagnostic value of procalcitonin (PCT) in urosepsis on 54 patients with urinary tract infections (UTI), suspected of having urosepsis. The results of urine culture, blood culture, and serum concentrations of PCT were analyzed. Overall, the sensitivity and specificity of PCT for bacteremia were as follows : 100 and 31.6% at concentrations of >0.5 ng/ml and 75.0 and 78.9% at concentrations of >10 ng/ml. we concluded that the PCT level could be a reliable early marker suggestive of urosepsis, and may be helpful when deciding whether to perform immediate urological intervention or not.

Immunohistochemical investigation of lymphatic vessel formation control in mouse tooth development: lymphatic vessel-forming factors and receptors in tooth development in mice

The presence of lymphatic vessels in dental pulp has recently been controversial, and no conclusion has been reached. In this study, we investigated the control of lymphangiogenesis with dental pulp development in the mouse mandibular molar using VEGF-C, VEGF-D, and VEGFR-3 as indices of lymphatic vessel-controlling factors. In addition, to distinguish blood and lymphatic vascular epithelial cells, we performed immunohistochemical analysis using von Willebrand factor (vWF) and statistical analysis. In dental papilla in the bell-stage non-calcified period, mesenchymal cells positive for VEGF-C, VEGF-D, and VEGFR-3 increased and lumen-forming endothelial cells were noted, but vWF was negative, suggesting that these were actively forming lymphatic vessels. Positive undifferentiated mesenchymal cells, an increase in endothelial cells in dental pulp, and lumen expansion were noted early after birth. Positivity was also detected in the odontoblast layer and sheath of Hertwig after birth, suggesting that these factors also play important roles in odontoblast differentiation and maturation and periodontal ligament and tooth root formation. We embryologically clarified lymphatic vessel formation in dental pulp and a process of lymphatic vessel formation from blood vessels, suggesting involvement of the surrounding tissue, odontoblasts, and sheath of Hertwig in vessel formation.

[A case of prostatic urethral calculus associated with perineal abscess and urethrocutaneous fistula]

A 37-year-old male who had sustained a lumbar vertebral fracture presented with the chief complaint of high fever and urine leakage from the perineal region. Computed tomography and urethroscopy showed a huge prostatic urethral calculus. He had a urethrocutaneous fistula in the perineal region. Transvesical prostate-urethrolithotomy, debridement of perineal abscess and cystostomy were performed. After operation, he had total incontinence during clamping of the cystostomy. Four months later, ileal-conduit formation and simple cystectomy were performed to improve urinary management. The pathogenesis of prostatic urethral calculus and the management of neurogenic bladder patients with spinal cord injury are reviewed.

[Development of nocturnal sleep behaviors in very low birth infants]

The objective of this study is to identify the developmental changes in nocturnal sleep behaviors among preterm infants in comparison with full-term infants (control group). The subjects were 18 preterm infants and 23 full-term infants with mean gestational weeks of 26.5 +/- 2.3 and 39.1 +/- 1.3, and average weights of 879 +/- 188 g and 2,940 +/- 352 g, respectively. Sleep measures were obtained through Actigraph (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY) over a week-long period. Results showed that the sleep duration was significantly different depending on the corrected age of months in only the preterm group (Preterm group: 504 +/- 55 min in under 12 months group, 543 +/- 68 min in over 13 months group. Full-term group: 548 +/- 68 min in under 12 months group, 544 +/- 79 min in over 13 months group). ACTX (percentage of minutes with higher than 0 activity score) was significantly higher for the preterm infants at both age groups in months. In conclusion, the nocturnal sleep duration of preterm infants reached the same level as those of full-term infants after the age of 13 corrected months. Also preterm infants were found to have a higher percentage of less restful sleep during nighttime. Further research is needed to understand the developmental course of physical activity during night time of preterm infants.

[Testicular mature teratoma with onset during childhood and removed 40 years later: a case report]

A 56-year-old man presented with a painless mass in the left scrotum. The mass was first noticed when he was a junior high school student,and it had been left for about 40 years. The intrascrotal tumor of 7 cm in diameter was elastic soft and smooth. The serum levels of α -fetoprotein, β -human chorionic gonadotropin and lactate dehydrogenase were within each individual normal range. He was diagnosed as having a left testicular tumor (cT1N0M0) and underwent left high orchiectomy. Histopathological diagnosis was mature teratoma without any malignant germ cell components. No evidence of recurrence has been observed for 4 years after the operation.

Comparing sleep measures of infants derived from parental reports in sleep diaries and acceleration sensors

AIM

Comparing sleep measures of infants derived from two data collection methods, acceleration sensors and sleep diaries, and identify the clinical application for each data collection method.

METHODS

The participants were 52 pairs of infants and mothers. Infant sleep measures were obtained through the actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY, USA) and sleep diaries for over a period of 7 days.

RESULTS

The results showed that the concordance in sleep measures derived from two methods showed decreases in the following order: sleep offset time [r=0.91 (p=0.00)], sleep onset time r=0.89 (p=0.00), nocturnal sleep duration [r=0.75 (p=0.00)], the number of night wakings [r=0.46 (p<0.01)] and WASO [r=0.34 (p<0.05)]. It was revealed that the accuracy of sleep diary records was affected by the sleeping place and varied throughout the study period.

CONCLUSION

It was confirmed that the sleep measures indicating sleep schedule reported from the sleep diaries had high concordances compared with the data from the actigraphs. Using the sleep diary was recommended to understand behaviours when focusing on infant's daily rhythms. In terms of accuracy and stability of recording throughout the study period, understanding sleep quality and independence of sleeping places, the choice of actigraph was recommended.

[A case of cystic pheochromocytoma mimicking liver abscess]

A 64-year-old man presented to our hospital feeling ill with epigastralgia. Computed tomography (CT) showed right suprarenal cystic tumor. High urinary catecholamine level was noted. Based on metaiodobenzylguanidine (MIBG) scintigraphy, magnetic resonance imaging and blood tests, preoperative diagnosis was adrenal pheochromocytoma. En-bloc resection of the tumor and the right kidney was performed. The cyst contained yellowish serous fluid, which had a catecholamine level about 3,000 times that in the blood. The histological diagnosis was cystic pheochromocytoma. Pathogenesis of cystic adrenal tumor is discussed briefly.

[A case of neobladder-cutaneo fistula after cystectomy]

A 69-year-old man was admitted for the treatment of muscle-invasive bladder carcinoma. Total cystectomy was performed and an ileal neobladder was constructed by a modification of Studer's method. However, a week later, a subcutaneous abscess occurred withwound dehiscence. Open drainage and wound debridement was carried out. Three weeks later, a neoblader-cutaneous fistula was seen on cystography. We managed it conservatively by means of wound debridement and washing with physiological saline. The fistula was closed on the 95th day after operation. The patient can now pass urine by himself.

[Status of the medical management of convulsive seizures at regular schools]

The nurse-teachers have important roles in health care of the students in Japanese schools. Usually one nurse-teacher works in each regular primary and junior high school in order to manage health care of the students. We surveyed the medical care of the students who had a history of convulsions by the questionnaires to 319 nurse-teachers. One hundred thirty nine nurse-teachers (93%) of 150 responders replied that they were taking care of at least one student with a history of convulsion. In 26 (17.4%) of the schools surveyed, more than one convulsion occurred between the first of April 2006 and the 31st of March 2007. More than 65% of nurse-teachers had witnessed convulsions at school. Results of the present study show 59 nurse-teachers were asked by parents to keep the rectal diazepam to administer to their children in the event of a convulsion. However, only 16 nurse-teachers received the instructions from a doctor on the indication of rectal diazepam. Sixty eight per cent of nurse-teachers felt that they had no or little support from doctors. Although most of the nurse-teachers felt reluctant to administer rectal diazepam at school, they considered the administration was unavoidable for student's safety and comfort. Clear instructions and detailed consultation by the doctors and prompt response in case of emergency were desired by the nurse-teachers. The establishment of the support system for the students with a history of convulsions is required to maintain safe and comfortable school life.

Sodium channels of SCNIA gene mutations in generalized epilepsy with febrile seizure plus (GEFS+) spectrum related to autism

Background Mutations in the a-subunit of the first neuronalsodium channel gene SCNIA have been demonstrated forgeneralized epilepsy \\lith febrile seizures plus (GEFS+), severemyoclonic epilepsy in infancy (SMEI), and borderline SMEI(SMEB). SCNIA mutations are also described in patients 'Withpsychiatric disorders such as autism.Objective To identify the mutations of SCNIA gene in patientswith GEFS+ spectrum which may be related to autism.Methods We examined four patients v.ith autism and GEFS+spectrum who were admitted to the Department of Child Health,Sardjito Hospital, Yogyakarta, Indonesia. Diagnosis of autism wasbased on DSM􀁟IV;ICD X criteria. Mutations in SCNIA wereidentified by PCRamplification and denaturing high􀁟performanceliquid chromatography analysis, Mth subsequent sequencing.Results There were four patients, all boys, aged 1.8 year to 7 years.The phenotypes of epilepsy were GEFS+ in one patient, SMEBin one patient and SMEI in two patients. Sequencing analysisrevealed a G􀁟to􀁟A heterozygous transition which was detectedat nucleotide c.4834G>A (p.V1612I ) in exon 25. Other singlenucleotid polymorphisms (SNPs) were c.383 +66T>C in intron 2,c.603-91G>A and c.603-1060> T in intron 4, c.965-21C> T inintron 6, c.1028+21T>Cin intron 7, c.2173G>A in exon 12 andc. 2177-38C>A, c.2177-12delT, c.2176+44C> T in intron 12.Conclusion In this study, we reported the first cases Mth mutationin SCNIA gene in GEFS+ spectrum related to autistic patientsin Indonesian population, which showed a missense mutationp.V16121. [Paediatr lndones. 2010;50:125-32].

[A case of renal perivascular epithelioid cell tumor (PEComa)]

A 44-year-old woman was admitted with acute hepatic dysfunction. Screening computed tomography showed an enhancing mass of about 9 cm in the right renal upper pole. An open right nephrectomy was performed for the pre-operative diagnosis of renal cell carcinoma. Pathological examination revealed a perivascular epithelioid cell tumor (PEComa). PEComa is a rare tumor, which includes angiomyolipoma and lymphangiomyomatosis. It is sometimes associated with aggressive clinical behavior such as local recurrence and metastasis. She had no evidence of recurrence at 34 months follow up.

[Small cell carcinoma of the urinary bladder detected by urinary cytology : a case report]

A 70-year-old man complaining of fever and chills was admitted to our hospital. A computerized tomography scan revealed a bladder tumor (cT3bN0M0), and urinary cytology demonstrated neuroendocrine carcinoma. Prostate specific antigen (PSA) was 4.089 ng/ml and human cytokeratin 19 fragment (CYFRA 21-1) was 3.8 ng/ml. He underwent transurethral resection of bladder tumor and needle biopsy of the prostate. Pathological examination demonstrated small cell carcinoma in the bladder tumor specimen and well differentiated adenocarcinoma (cT1c) with a Gleason score of 34 in the prostatic specimen. He underwent cystoprostatectomy with bilateral cutaneous ureterostomy. He did not receive adjuvant chemotherapy because of the poor postoperative systemic condition and he died of acute myocardial infarction 5 months later.

Activity-based assessment of the sleep behaviors of VLBW preterm infants and full-term infants at around 12 months of age

PURPOSE

The aim of this study is to identify the characteristics of sleep behaviors assessed from activity data among very low-birth weight (VLBW) preterm infants in comparison to full-term infants at the age of around 12 corrected months, due to the possibility that sleep behaviors of preterm infants may be different from those of full-term infants.

METHOD

Cross-sectional study. Infant sleep measures were obtained through actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY), which were attached to the infants' ankles during a week-long period. The subjects were 14 preterm infants and 14 full-term infants in which the mean ages were 13.3+/-2.1 corrected months and 12.3+/-2.4 month, respectively.

RESULTS

Preterm infants showed significantly less sleep duration during nighttime than full-term infants. The mean activity score and ACTX (Activity Index: percentage minutes with more than 0 activity score) of preterm infants during nighttime were significantly higher than those of full-term infants. No significant differences in total sleep duration, daytime sleep duration, the number of night-wakings, and sleep efficiency were found between the two groups.

CONCLUSION

Preterm infants slept less and had a larger percentage of less restful sleep during nighttime. The results indicated that prematurity at the time of birth remained throughout the developmental course of sleep behaviors among preterm infants at around the age of 12 corrected months.