A community cluster of influenza A(H1N1)pdm09 virus exhibiting cross-resistance to oseltamivir and peramivir in Japan, November to December 2013.

Six influenza A(H1N1)pdm09 viruses were detected in Sapporo, Japan, between November and December 2013. All six viruses possessed an H275Y substitution in the neuraminidase protein, which confers cross-resistance to oseltamivir and peramivir. No epidemiological link among the six cases could be identified; none of them had received neuraminidase inhibitors before specimen collection. The haemagglutinin and neuraminidase genes of the six viruses were closely related to one another, suggesting clonal spread of a single resistant virus.

Internal jugular vein reconstruction: application of conventional type A and novel type K methods.

BACKGROUND: During neck dissection, the current practice is to preserve the internal jugular vein in the majority of cases. However, sacrifice of bilateral internal jugular veins is required in rare cases. Simultaneous excision of both internal jugular veins is known to frequently cause fatal complications. Even if staged, bilateral internal jugular vein sacrifice still occasionally leads to fatal complications (in 2 per cent). We report two different methods of unilateral internal jugular vein reconstruction, in two cases requiring excision of bilateral internal jugular veins, and we review the significance of this reconstruction procedure. METHOD: The first patient underwent conventional type A reconstruction (using Katsuno's classification): end-to-end anastomosis of the internal jugular vein to the external jugular vein. For the second patient, we anastomosed the internal jugular vein to the anterior jugular vein, preserving the flow of the external jugular vein. This method, termed type K, had two main expected benefits: facial drainage via the preserved external jugular vein; and provision of a built-in safeguard in the case of occlusion (via the preserved venous networks between the internal jugular vein and the external jugular vein, e.g. the facial vein). RESULTS: In both cases, the reconstructed internal jugular vein was patent and the post-operative course was uneventful, with no severe complications. CONCLUSION: The current and previous findings strongly indicate that the reconstruction of at least one internal jugular vein is highly recommended for patients requiring bilateral internal jugular vein sacrifice. Our type K method may represent a useful technique for this procedure.

[Expression of Fas-antigen on T cells in multiple sclerosis].

We reported the expression of Fas antigen and activation markers (HLA-DR,CD69) on T cells in 14 patients with multiple sclerosis (MS) and healthy controls. The percentage of Fas antigen positive T cells was 29.7 +/- 7.8% in patients with untreated MS. This value was statistically higher than 17.7 +/- 10.5% of healthy controls (p = 0.03). But there was no significant difference in the rate of activation markers in peripheral blood between two groups. Fas antigen and activation markers in cerebrospinal fluid (CSF) in patients with MS tend to be higher than those in peripheral blood. High expression rate of Fas antigen and activation markers on T cells in CSF may be reflecting increased induction of apoptosis on activated T cells.

[A case of acute pandysautonomia and diffuse brain stem impairment associated with EB virus infection].

A 37-year-old woman with complaints of headache and nausea presented with temporary disturbance of consciousness, bulbar palsy and ataxic speech following flu-like symptoms. After the recovery of her consciousness, she developed orthostatic syncope and numbness all over the body. When she was admitted to our hospital two months later, she showed emaciation, diminished sweat production and butterfly-patch-like pigmentation. Neurologic examinations were remarkable for anisocoric pupils that sluggishly reacted to light, impaired left facial movements, bulbar palsy, numbness of the whole body, total loss of all tendon reflexes, incordination, ataxic gait and severe postural hypotension. Laboratory data included albuminocytogenic dissociation in cerebrospinal fluid, convergence nystagmus and dysmetria in electronystagmography, and right trigeminal paralysis in blink reflex. A sural nerve biopsy showed active axonal degeneration and severe loss of both myelinated and unmyelinated fibers. Examinations of autonomic nervous system disclosed diffuse impairment of sympathetic and parasympathetic postganglionic nerve. Based on these findings she was diagnosed as having acute pandysautonomia. High titer of serum EB virus antibody suggested that acute pandysautonomia and diffuse brainstem impairment may be related to EB virus infection.

[A case of chronic herpes encephalitis with myelodysplastic syndrome (MDS)].

A 72-year-old male suffering with MDS was admitted to our hospital because of slowly progressive dementia, convulsions and consciousness disturbance. A CT scan of the brain showed a low density area in the right temporal to parietal lobe and T2-weighted MRI of the brain revealed a high intensity signal in the same area. Herpes simplex virus DNA was detected in CSF by PCR method. He was diagnosed as having herpes simplex encephalitis but his clinical course was prolonged and considered atypical as herpetic infection in CNS. However, after administration of aciclovir, progression of his symptoms stopped, and a CT scan still revealed abnormal findings with the same area after more than four months. We thought his chronic course of herpes encephalitis was caused by incomplete immune function suppressed by MDS.

[Peripheral blood gamma delta T cells in multiple sclerosis].

The presence of T lymphocytes bearing the gamma delta T cell receptor (gamma delta T cells) has been studied in peripheral blood from 21 patients with multiple sclerosis (MS) and 13 normal controls. The amount of gamma delta T cells of CD3 positive T cells in MS was (mean +/- SEM; 7.7 +/- 1.3%) higher than in normal controls (5.5 +/- 1.0%), but not significantly. However, in MS group, 6 patients had definitely a higher frequency of gamma delta T cells, exceeding the mean +/- 2SD of normal control (22.3, 18.5, 17.7, 14.8, 12.0, 10.3%). Furthermore, there is no correlation between the presence of gamma delta T cells and disease type, clinical course, disease duration and disability score. But some patients with short disease duration tend to have higher proportion of gamma delta T cells than in other patients. It is suggested that gamma delta T cells might be related to causes of the disease of some MS patients in early phase.

Na+/H+ exchanger and reperfusion-induced ventricular arrhythmias in isolated perfused heart: possible role of amiloride.

The roles of the Na+/H+ exchange system in the development and cessation of reperfusion induced ventricular arrhythmias were studied in the isolated perfused rat heart. The hearts were perfused in the working heart mode with modified Krebs Henseleit bicarbonate (KHB) buffer and whole heart ischemia was induced by a one-way ball valve with 330 beat/min pacing. Ischemia was continued for 15 min followed by 20 min of aerobic reperfusion (control). Amiloride (1.0 mM), an inhibitor of the Na+/H+ exchange system, was added to the KHB buffer only during reperfusion (group B) or only during ischemic periods (group C). Electrocardiographic and hemodynamic parameters were monitored throughout the perfusion. Coronary effluent was collected through pulmonary artery cannulation and PO2, PCO2, HCO3- and pH were measured by blood-gas analyzer. The incidence of reperfusion induced ventricular arrhythmias was 100%, 100% and 0% in control, group B and group C, respectively. The mean onset time of termination of reperfusion arrhythmias was significantly shorter in group B than in control. PCO2 increased from 39.0 +/- 0.9 to 89.3 +/- 6.0 mmHg at the end of ischemia in control and from 40.6 +/- 0.4 to 60.5 +/- 5.8 in group C, the difference between groups was statistically significant. HCO3- level decreased from 21.8 +/- 0.1 to 18.3 +/- 0.5 mmol/l in control, however, this decrease was significantly inhibited in group C (from 22.0 +/- 0.5 to 20.3 +/- 0.2). The increase in PCO2 and the decrease in HCO3- in group B were similar over time to those observed in control.(ABSTRACT TRUNCATED AT 250 WORDS)

Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis.

Patellar height in the lateral view of radiograms was measured on 94 knees of 61 women before and after total knee arthroplasty in order to study postoperative changes of position. The mean age of patients at surgery was 58.4 years (range, 30-77 years). Eighty-one knees were rheumatoid and 13 osteoarthritic. Inserted prostheses were Kinematic anteriorly joined type in 49 knees, Kinematic posterior cruciate retention type in 19, and UCI type in 26. The observation period ranged from 6 months to 9 years, with an average of 2.6 years after surgery. The ratio of length of the patellar ligament to that of the patella (Insall-Salvati's ratio) decreased by more than 10% of preoperative value in 61 knees, remained unchanged in 31, and increased in only 2. The average ratio was 0.93 +/- 0.16 before surgery and 0.75 +/- 0.20 at the final follow-up examination (P less than .01).