Plasmapheresis for a Female with Cryptogenic New-Onset Refractory Status Epilepticus Not Benefiting from Monoclonal Antibody Therapy

Monoclonal antibodies are pure antibodies that react to a specific epitope. Plasmapheresis is a treatment that separates and eliminates disease-causing substances before replacing the blood with plasma. Plasmapheresis has insufficient evidence for treating new-onset refractory status epilepticus (NORSE). Sequential plasmaphereses gradually improved a female cryptogenic NORSE patient who did not benefit from monoclonal antibody treatment.

An Unusual Type of Hypertrophic Cardiomyopathy

An unusual type of hypertrophic cardiomyopathy was diagnosed in a 17-year-old girl who presented with dyspnea on exertion. The hypertrophied myocardium was localized to the anterior portion of the left ventricle from the base to the apex without left ventricular outflow tract obstruction. On cardiac magnetic resonance imaging (MRI), patchy and linear delayed hyperenhancement was shown in the anterior and inferior mid-wall, which is not concordant with the coronary artery territory.

Studies on the Metagonimus fluke in the Daecheong reservoir and the upper stream of Geum river, Korea

The prevalences of the fluke belonging to genus Metagonimus have been reported along the upper stream of inhabitants by several workers since 1980, however the taxonomical problems of the fluke was not yet settled. The larval flukes; cercaria and metacercaria as well as their intermediate hosts, and adult were studied in order to identify the Metagonimus in the areas. The results obtained are summarized as follows: The snails, Semisulcospira globus were collected from the three different localities along the upper stream of the River. The cercariae were found from 125(7.2%) out of 1,730 snails by natural emerging method, and were identified into 5 species including Metagonimus sp. (3.7%), Pseudexorchis major(1.4%), Cercaria nipponensis (0.9), Cercaria incerta (0.6%) and Cercaria yoshidae(0.6%). Cercariae of Metagonimus species had four to five oral spines on its anterior of the first line. The cercariae of Metagonimus were experimentally exposed to goldfish. Infection rate was 22.9% out of 105 goldfish, and the encysted metacercariae were found in fins(86.7%) and on scales (13.7%) of the fishes, but not in their muscle, head or visceral organs. Seven species of fish were caught in the Daecheong reservoir and the upper stream. Infestations with metacercaria of Metagonimus were found 100% in Opsariichtys bidens and the parasitized numbers of the metacercariae were observed from 250 to 2,400 per fish. In the upper stream, Zacco temmincki, Z. platypus and Pseudogobio esocinus were infected 100% with the metacercaria, on the other hand, the fishes caught in the reservoir showed the lower infestation rates, and a few metacercariae found in the fishes Carassius carassius and Cyprinus carpio in the reservoir and the stream. The majority of metacercariae was detected only on the scales of fishes. In order to know the infectivity and the distribution patterns in the intestine of hosts, rats and dogs were infected with the metacercariae obtained from O. bidens and Z. platypus. In addition the metacercariae obtained from Z. temmincki, P. esocinus and goldfish were given to the rats. The recovery rates of the worms in the small intestine of dogs were higher (63.3-65.8%) than those of the rats (3.5-31.6%). The flukes were found mostly in the middle and the lower part of small tntestine of the rats and the dogs, but no worm was collected in the upper part of the intestine of rats. The size of adult flukes varied by the hosts. In the adult flukes, oral sucker was smaller than ventral sucker, and the right and left testes were located diagonally, the uterine tubules circled around the upper left testis. The average egg size was 29.1 x 17.7 micro-meter. According to the above results, the flukes belonging to genus Metagonimus distributed along the Geum River was concluded to be identical with Miyata type of M. yokogawai as that Saito had proposed.