The possible intraspousal transmission of HCV in terms of lichen planus.

Lichen planus (LP), common mucocutaneous disorder, involves not only oral mucosa and skin but genitalia membrane. LP is frequently seen in patients with HCV infection. This study evaluated patients with HCV-associated oral lichen planus (OLP) for vulvar and vaginal LP involvement, and the possible intraspousal transmission of HCV. We examined a total of 24 female Japanese patients with OLP for genitalia LP: 14 OLP-HCV positive and 10 OLP-HCV negative. All subjects were evaluated for genital LP by a gynecologist. All 24 subjects and 10 of the husbands were tested for anti-HCV and serum HCV RNA. Vulvar LP was observed in 10 (41.7%) of 24 patients with OLP. Vulvar LP in 14 (OLP-HCV positive) and 10 patients (OLP-HCV negative) were observed in 42.9 and 40%, respectively. There were no significant differences (age, sites of OLP, blood transfusion, HCV infection, and degree of liver diseases) between the vulvar LP and non-vulvar LP patients. Two spouses of 10 married couples were shown to be infected with HCV. In one couple with HCV infection, the wife and husband had also erosive OLP, the wife had erosive vulvar LP. In conclusion, the majority of OLP patients suffered from genitalia LP in Japan. Clinicians should follow the OLP patients with sufficient attention to the presence of extraoral manifestations. These data may suggest the occurrence of intraspousal transmission of HCV through erosive vulvar LP.

High prevalence of anticardiolipin antibodies in patients with HCV-associated oral lichen planus.

Hepatitis C virus (HCV) has been linked to extrahepatic manifestations such as oral lichen planus (OLP). In addition, anticardiolipin antibodies (aCL) and cryoglobulin have been demonstrated in chronic hepatitis C. The aim of this study was to investigate these prevalences in patients with HCV-associated OLP. The prospective study investigated the role of these factors in 133 subjects: 28 with OLP-HCV(+) (group 1), 22 with OLP-HCV(-) (group 2), 33 without OLP-HCV(+) (group 3), and 50 healthy volunteers matched for age and sex served as control group (group 4). Levels of immunoglobulin G (IgG) and IgM aCL antibodies, and cryoglobulin in serum were evaluated by enzyme-linked immunosorbent assay. The prevalence of aCL in groups 1, 2, 3, and 4 were 32.1, 18, 36.3, and 8%, respectively. The positive rate of aCL was significantly higher in groups 1 and 3 than that in the control group (group 1; p=0.02 vs. the control group, group 3; p<0.01 vs. the control group). There were no significant differences in cryoglobulin among the groups. The findings of the present study showed a high prevalence of IgG and IgM aCL in the serum of patients with HCV infectious diseases. A positive factor for aCL was determined by age, sex, the presence of OLP, and HCV infection.

Correlation between antimicrobial activity and chelating ability of 2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates.

The chelating abilities of phosphobetaines [2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates; 1] for divalent cations (e.g., calcium ion, zinc ion, copper ion, and cadmium ion) were investigated to elucidate the correlation between the antimicrobial activity and the chelating ability. The maximal chelating ability was obtained with the compound having a dimethylene bridge as an intercharge distance between the phosphate and quaternary ammonium group; in contrast, the minimum was obtained with the compound with a trimethylene bridge. These behaviors paralleled the antimicrobial activity of these compounds. The antimicrobial activities, in terms of log (1/MIC) (minimum inhibitory concentration, mumol/L) of homologues of 1 against Candida albicans and Propionibacterium acnes were found to correlate linearly with the chelating ability for the calcium ion. This linear relationship is discussed with respect to the structure of the phosphobetaine moiety in the molecule of 1.

Relation between structure and antimicrobial activity of 2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates.

A series of phosphobetaines [2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates], having different alkyl chains and a methylene bridge separating the phosphate and ammonio group, was investigated in order to provide a new antimicrobial agent. Maximal activity was obtained with the compound having a hexadecyl group as a long-chained alkyl group, two methyl groups as short-chained alkyl groups, and a dimethylene bridge as an intercharge distance. In contrast, sodium 2-(N-hexadecyl-N-methylamino)ethyl hydrogen phosphate, 2-(N-hexadecyl-N,N-dimethylammonio)-1-hydroxyethyl iodide, and N-octadecyl-N,N-dimethylammonio acetate showed decreased activity, indicating that the presence of a phosphobetaine moiety was essential for activity. Thus, 2-(N-hexadecyl-N,N-dimethylammonio)ethyl hydrogen phosphate has been found to possess strong antimicrobial activity and a broad antimicrobial spectrum against nine kinds of bacteria (e.g., fungi, yeast, gram-negative and gram-positive bacteria), which are comparable with those of chlorhexidine digluconate.

Late infection after cranioplasty--review of 14 cases.

The incidence of late infection after cranioplasty was studied in 130 patients with 133 cranioplasties. The materials used were prefabricated resin in 62 cases, autogenic bone in 38, intraoperatively fashioned resin in 25, and vitallium in eight. Six infections were documented, for an infection rate of 4.5%. In addition to these six cases, we studied eight patients with infections who had undergone cranioplasty elsewhere but had the infected plates removed in our hospitals. Among the 14 cases of infection, the intervals between cranioplasty and plate removal were 3 to 43 months (average, 10.5 months). The eight patients referred from other hospitals had a significantly shorter average interval between external decompression and cranioplasty than did patients who did not develop infection (2.6 versus 6.7 months; p less than 0.005). Systemic signs were mild despite obvious local signs of infection. Of the 11 first infections, nine (82%) were associated with discharge of pus from a fistula; in these cases a galeal suture had become infected apparently through scratching by the patients. In contrast, in the three patients who had had a previous infection, the second infection manifested as subgaleal and epidural empyema or meningitis without a fistula or pus discharge. Nine infections (69%) were due to Staphylococcus. All but two patients required removal of the infected plates. One recovered with conservative therapy and one died of meningitis, giving a mortality rate of 0.8%. No matter how mild the systemic signs, late infection warrants surgical debridement and plate removal. The risk factors for late infection of cranioplasty are discussed.

[A case of myelopathy caused by calcified nodules of cervical ligamentum flavum].

A case is reported of a 71-year-old female with cervical myelopathy caused by calcified nodules in the cervical ligamentum flavum and improved by en bloc laminectomy. The calcified nodules were formed by the deposition of two crystals, hydroxyapatite (HAP) and calcium pyrophosphate dihydrate (CPPD). Light microscopy, scanning electron microscopy, energy dispersive X-ray microanalysis and X-ray diffraction study disclosed that the larger nodule located on the right was composed mainly of HAP in the central part and CPPD in the circumference. On the other hand, the smaller nodule located on the left was composed mainly of CPPD crystal. These findings support the hypothesis that calcification of the ligamentum flavum and CPPD crystal deposition disease in the cervical region are the same entity and the both are merely different aspects of the same entity at different chronological stages.

[Delayed intracerebral hemorrhage following VP shunt operation].

Three cases of communicating hydrocephalus after subarachnoid hemorrhage are reported that underwent ventriculoperitoneal shunt and suffered from delayed intracerebral hemorrhage along the ventricular catheter. Ventricular catheters were inserted into the posterior horn with minimal brain damage by our method, in case 1 and 2, 3 times try of ventriculostomy, in case 3, replacement along the same route on the shunt revision. Blood pressure control after the operation was good and bleeding tendency was not observed. Vascular anomaly was not found in preoperative angiography in any case. In case 1, 60 year-old man, intracerebral hemorrhage occurred on the 7th-9th postoperative day as the result of respiratory acidosis and generalized convulsion which needed assisted ventilation for two days. In case 2, 54 year-old man and case 3, 59 year-old woman, headache and hemiparesis suddenly developed immediately after micturition 4 days after operation. Postoperative CT scan revealed that cranioplasty, performed at the same time as shunt operation, caused mass effect on the shunted side of the brain in case 2. In case 3, VP shunt system revised did not seem to function so well. These conditions might predispose the shunted brain to bleed, in addition to the increased intracranial pressure or blood pressure probably produced by Valsalva effect at micturition. These cases indicate that the small surgical wound in the brain induced by shunt procedure could cause progressive degenerative vascular change and bring about delayed intracranial hemorrhage under some predisposing factors.

[A case of spontaneous cervical epidural hematoma associated with cervical spondylosis].

A case of spontaneous cervical epidural hematoma associated with long-term cervical spondylosis is presented. A 69-year-old man was admitted with a 3-day history of sudden onset of severe neck pain radiating to both upper extremities followed by impossibility in standing. Neurological examination on admission revealed paralysis below C7, total anesthesia below the T4 level and urinary incontinence. Initially, he was diagnosed as cervical cord injury caused by a violent fall. Subsequently, skeletal traction with tongs of the Crutchfield design was carried out. Nevertheless, he developed spinal shock 6 days after admission. A metrizamide myelogram followed by CT scanning 5 days after admission demonstrated an extradural isodensity mass displacing dura forward. The mass lesion was confirmed as spontaneous epidural hematoma by laminectomy from C4 to C7. Sudden onset of neck pain with radiation into both upper extremities should be differentiated cervical epidural hematoma from other cervical spinal lesions. Metrizamide CT is helpful to diagnose cervical epidural hematoma.

Subdural tension pneumocephalus following surgery for chronic subdural hematoma.

The computerized tomography (CT) findings were analyzed in five cases of subdural tension pneumocephalus following surgery for chronic subdural hematoma. They were compared with CT scans in 14 cases of asymptomatic subdural pneumocephalus. In this study, two new CT findings were identified that suggest increased tension of the subdural air. Subdural air separates and compresses the frontal lobes, creating a widened interhemispheric space between the tips of the frontal lobes that mimics the silhouette of Mt. Fuji. The presence of air between the frontal tips associated with massive air inclusion over the frontal lobes presumably indicates increased tension of the subdural air. The "Mt. Fuji sign" was seen in four of the five cases with subdural tension pneumocephalus. The other finding was the presence of multiple small air bubbles scattered through several cisterns ("air bubble sign"). It is postulated that these air bubbles enter the subarachnoid space through a tear in the arachnoid membrane caused by increased tension of air in the subdural space. This finding was seen in four cases with subdural tension pneumocephalus. These two CT findings are helpful in making a diagnosis of subdural tension pneumocephalus following surgery for chronic subdural hematoma.

[Subdural tension pneumocephalus following surgery of chronic subdural hematoma].

Subdural tension pneumocephalus (TP) following surgery for chronic subdural hematoma was analyzed in 5 cases from clinical standpoints of view, especially from CT findings. The cases were compared with 14 cases of subdural asymptomatic pneumocephalus (AP). The TP tends to complicate elderly patients who showed a poor re-expansion of the brain after irrigation of bilateral chronic subdural hematoma. In such patients, it is difficult to make an exact diagnosis of TP because of residual mass effect of the evacuated hematoma. Significance of mass effect caused by subdural air has been discussed in the literature only little. In this study, we found two new CT findings suggesting increased tension of subdural air. First, the subdural tensive air separates and compresses the frontal lobes. The compressed frontal lobes with widened interhemispheric space between the frontal poles mimic the silhouette of Mt. Fuji. We called this CT finding "Mt. Fuji" sign. The presence of air between the frontal poles associated with massive air over the frontal lobes presumably indicates an increased tension of the subdural air. "Mt. Fuji" sign was seen in 4 cases out of 5 TP cases. Another sign is the presence of multiple small air bubbles in the subarachnoid space, especially in the cisterns. We proposed that these air bubbles were trapped in the subarachnoid space through a tear of the arachnoid membrane which is caused by increased tension of air in the subdural space. This finding was present in 4 cases with TP. We emphasize that these two CT signs are helpful to make an accurate diagnosis of TP following surgery for chronic subdural hematoma.

[Percutaneous transluminal angioplasty in subclavian artery stenosis].

The technique of percutaneous transluminal angioplasty (PTA) that was introduced initially by Dotter and Judkins in 1964 has been applied to various arterial stenoses and some occlusive lesions and has advanced dramatically with the development of the Grüntzig catheter in the treatment of peripheral vascular disease. However, the application to occlusive disease in brachiocephalic arteries is still considered to be disputable and has been made only in selective cases, especially in Japan. We report here a case with stenosis of the left subclavian artery successfully treated with PTA. The patient was 66 year-old man, who had been suffering from transient attacks of vertigo, ataxia, visual disturbance and the left arm claudication. Blood pressure was 150/92 mmHg in the right arm and 110 mmHg in systole in the left arm. Diagnostic arteriography identified the right carotid artery occlusion at its origin and significant stenosis in the proximal left subclavian artery. PTA under fluoroscopic control was performed by passing dilating catheter in antegrade fashion by Seldinger method through the left femoral artery. Anatomic correction was achieved without hemorrhagic or embolic complications. Systolic blood pressure gradient measured at the brachial artery level disappeared immediately after PTA and symptomatic relief was obtained completely. One month later, wide patency of the left subclavian artery and sufficient antegrade flow in the vertebral artery were confirmed angiographically. During follow-up period of 4 months, the patient was asymptomatic. We reviewed the literature reporting PTA for occlusive disease in brachiocephalic arteries and discussed its problems and possibilities, especially for the treatment of subclavian artery stenosis.

[A case of quadriplegia with respiratory paralysis surviving as a candidate for rehabilitation].

A case of a 20-year-old woman who survived respiratory quadriplegic state and then became to be a candidate for rehabilitation is reported. The patient was injured in an automobile accident and immediately developed cardiopulmonary arrest, quadriplegia and maximum mydriasis bilaterally. She was transferred to our hospital six minutes after the accident. Immediate and appropriate resuscitation could bring restoration of only cardiac contractions without spontaneous breathing and minimal movement of extremities. Skull and cervical spine x-rays showed anterior atlanto-axial dislocation with a fracture of dens in addition to a linear skull fracture in the right temporoparietal region. Traction by Glisson's method was applied initially three and a half hours after the accident under controlled ventilation with a respirator. Five days after the onset, her consciousness became clear and she displayed an onionskin pattern of anesthesia with sensory preservation around her mouth and nose. Subsequently quadriplegia gradually improved from the lower extremities to the upper, however the proximal muscles of the upper extremities remained to be involved for a long period of time. The authors speculated that such a peculiar pattern of paralysis was due to the injury of the rostral part of the pyramidal decussation and to the acute central cord injury at the C2 level of the spinal cord. Halo-vest immobilization technique was applied and active postural drainage was done as the treatment of the respiratory quadriplegia. She could wean off the respirator four months after the onset and became independent in her active daily living six months after the accident.(ABSTRACT TRUNCATED AT 250 WORDS)