ABSTRACT
BACKGROUND AND PURPOSE: The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. However, in some cases, it shows T1 high signal. We evaluated the imaging and pathologic findings to identify the causes of the T1 high signal in the transmantle sign. MATERIALS AND METHODS: We retrospectively reviewed the preoperative imaging data of 141 consecutive patients with histologically proved focal cortical dysplasia. We selected 25 patients with focal cortical dysplasia with the transmantle sign and divided them into groups based on the pathologic focal cortical dysplasia subtype and T1 signal of the transmantle sign. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and compared them among the groups. RESULTS: Nine of the 25 patients had a T1-high-signal transmantle sign; the other 16 patients did not. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). Of the 16 patients with no T1-high-signal transmantle sign, 13 were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). The number of balloon cells was significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity of gliosis, or calcifications. CONCLUSIONS: Approximately 6% (9/141) of this patient series had a T1-high-signal transmantle sign, and all were type IIb. The signal may reflect a rich density of balloon cells. This finding could support the differentiation of subtypes, especially type IIb.
Subject(s)
Epilepsy/diagnostic imaging , Epilepsy/pathology , Magnetic Resonance Imaging/methods , Malformations of Cortical Development, Group I/diagnostic imaging , Malformations of Cortical Development, Group I/pathology , Neuroimaging/methods , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Image Interpretation, Computer-Assisted/methods , Male , Retrospective Studies , Young AdultABSTRACT
The successful and persistent abolition of the inhibitor is of significant clinical benefit, as it allows for the restoration of the usual treatment with clotting factor concentrate. We describe a successful induction of immune tolerance by continuous infusion of recombinant factor VIII (rFVIII) in a 5-year-old boy with severe haemophilia A and high-responding inhibitor. He had previously been subjected to immune tolerance induction (ITI) with rFVIII at 100 units (U) kg(-1) three times weekly. One year after the beginning of therapy tolerance was not achieved and a high titer of inhibitor was detected (15 Bethesda Units). The patient had a sudden onset of severe neck pain. The diagnosis of spinal epidural haematoma was revealed by magnetic resonance imaging, and emergency laminectomy with evacuation of the haematoma was required. The patient received sequential therapy for surgery first as bolus rFVIII injection of 500 U kg(-1) in order to overwhelm the inhibitor and then as continuous infusion at 6 to 12 U kg(-1) hour(-1) to avoid bleeding episodes in the postoperative period. After the 3 weeks of continuous infusion, the inhibitor became undetectable. Thereafter, prophylactic treatment with rFVIII was started three times weekly, and the inhibitor has remained undetectable for 6 months. The, present case suggests that continuous infusion of rFVIII may be an effective therapy to induce immune tolerance.
Subject(s)
Factor VIII/administration & dosage , Hemophilia A/drug therapy , Immune Tolerance/immunology , Child, Preschool , Factor VIII/antagonists & inhibitors , Hematoma, Epidural, Spinal/complications , Hematoma, Epidural, Spinal/surgery , Hemophilia A/complications , Hemophilia A/immunology , Humans , Infusions, Intravenous , Male , Treatment OutcomeABSTRACT
We encountered a terminal lung cancer patient with severe back pain and dyspnea who refused the use of morphine, and succeeded in home palliative care with the use of an original prescription (CA), the main ingredient of which was codeine phosphate.
Subject(s)
Analgesics, Opioid/therapeutic use , Codeine/therapeutic use , Dyspnea/therapy , Home Care Services, Hospital-Based , Lung Neoplasms/physiopathology , Pain, Intractable/drug therapy , Palliative Care , Aged , Female , Humans , Morphine , Oxygen Inhalation Therapy , Rejection, PsychologyABSTRACT
We think that death at home has increased among patients from our hospital due to following factors: 1) solid cooperation with visiting nurse stations, 2) progress in judgments of care ability, 3) changes in family consciousness, 4) enrichment of other support systems for home care.
Subject(s)
Attitude to Death , Home Care Services, Hospital-Based/organization & administration , Neoplasms/nursing , Terminal Care , Humans , Social Support , Terminal Care/organization & administrationABSTRACT
The Pharmacy Department at our hospital is attempting to develop methods for palliative care, for example of cancer pain or smelly tumors. The participation of pharmacists on the medical team for home care is necessary, because the supply of proper drugs for patients' individual conditions is indispensable in palliative care. Communication between not only patients, but also between their families and us, as well as the maintenance of close contact with the medical team, are important in home care.
Subject(s)
Palliative Care , Patient Care Team , Pharmacists , Cooperative Behavior , Humans , Pharmacy Service, HospitalABSTRACT
Recently, cases of home medical treatment for terminal cancer have increased in our hospital. Close teamwork with a regional visiting nurse station may be useful for home care of distant patients.
Subject(s)
Home Care Services , Patient Care Team , Terminal Care , Female , Humans , Middle Aged , Nursing StaffSubject(s)
Biliary Tract Diseases/surgery , Common Bile Duct/surgery , Adult , Dilatation, Pathologic , Female , HumansABSTRACT
Studies on the activity of the glucuronic acid pathway in alloxan diabetic rabbits were carried out. Amount of D-glucaric acid, L-ascorbic acid, and D-glucuronic acid in urine increased in the case of the alloxan diabetic rabbits. The transformation from D-glucuronolactone to D-glucaric acid was higher than normal in the diabetic animals. The expired 14-CO2 decreased and urinary excretion of labeled L-gulonic acid increased after administration of 6-14-C-glucuronolactone in the diabetic rabbits. L-Gulonic acid dehydrogenase, lactonase II, and beta-glucuronidase activities were reduced, and UDPGA-pyrophosphatase, D-glucuronic acid-1-phosphatase, and UDPGA-transferase activities increased in the diabetic rabbit liver. From these results, it may be concluded that an increase of endogenous D-glucuronic acid in the diabetic states could be attributed to a metabolid defect in the step of L-gulonic acid dehydrogenation and to the enhancement of UDPGA-pyrophosphatase and D-glucuronic acid-1-phosphate phosphatase activities.
