Intracranial hemorrhage in children with immune thrombocytopenic purpura

We sent questionnaires to hospitals in Japan in order to study the incidence and conditions of intracranial hemorrhage (ICH) in children with immune thrombocytopenic purpura (ITP). From 1980 to 1995, 11 cases of ICH were reported in eight patients with ITP at 35 institutions. One patient had ICH four times, but only one patient died of the condition. From 1990 through 1995, ICH occurred in four (0.52%) of 772 patients with ITP. None of the patients died. The platelet count when ICH occurred was 5.2 +/- 3.7 x 10(9)/l (mean +/- SD) (n = 11). Four of the eight patients (1980-1995) had received active treatment [e.g. intravenous immunoglobulin G (i.v. IgG)] immediately before ICH occurred. In seven cases (1980-1995), possible causes of ICH, including menstruation (n = 2) and viral infections (n = 3), were identified. Systemic lupus erythematosus (SLE) later developed in three patients. Although the incidence of ICH in children with ITP has not decreased compared with the rates in earlier studies, the mortality rate has decreased markedly. Our results suggest that menstruation, infection, and risk factors for progression to SLE may help to predict ICH in children with ITP. Large-scale prospective trials are needed to identify risk factors for ICH.

Use of an accelerometer in evaluating arm movement during wheelchair propulsion

A piezoelectric accelerometer was attached to the arm of a wheelchair bound subject to obtain information on arm movement during wheelchair propulsion. Five physically fit normal subjects, seated on a suspended wheelchair in a laboratory setting, propelled a wheelchair 60, 90 and 120 times/min in succession for a total of 4 min each. With increased frequency of arm propulsion, arm acceleration also increased. A statistically significant (P < 0.05) relationship was found between arm acceleration and frequency of arm propulsion showing a linear regression correlation of Y = 0.118X-1.122. A clinical trial using the same recording system for a paraplegic athlete on a 160 m two way (80 m each way) track confirmed the system's practicality. Arm acceleration data may be extrapolated to frequency of arm propulsion or level of activity information. Complete computerization of the accelerometric data will facilitate its expansion to a variety of practical applications.

[Surgical managements of the compression of trachea and/or bronchus associated with congenital cardiovascular anomalies]

From 1987 through 1990, 17 cases with tracheal and/or bronchial compression due to congenital cardiovascular malformations were experienced at our institutes. Respirator was required preoperatively in 10 patients (59%) due to severe respiratory symptoms by airway compression and narrowing. In all cases, bronchoscopy was carried out pre- or intra-operatively for the precise diagnosis and for the decision of operative procedures. Postoperatively 12 cases were successfully extubated and remained free of respiratory distress. We investigated the relationships among pre- and post-operative pressure ratio, preoperative flow ratio, requirement of preoperative respirator and indication for plication and suspension of pulmonary artery in the group of the patients, who had airway compression by the dilated pulmonary artery due to large left to right shunt. As a result of this investigation, these factors have no significant correlation. The severity of associated tracheomalacia might be a most susceptible cause, which required the preoperative managements with respirator and the surgical interventions to the dilated pulmonary artery. Infant with patent ductus arteriosus (PDA) could be surgically treated by the division of PDA through left lateral thoracotomy. If the left main bronchus shows complete obstruction after division of PDA, the additional surgical intervention like suspension of aortic arch is needed. Two cases were lost with reoperation and these suggested not only the priority of simultaneous repair of trachea and cardiovascular anomaly, but the necessity of minor intervention against adhesion (insertion of Gore-Tex sheet between suspended pulmonary artery and sternum) in the first-step palliative operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[2 surgically treated cases of adrenocortical carcinoma producing steroid hormones without endocrinological symptoms--case report and a review of cases in the Japanese literature]

We have experienced two male cases of an adrenocortical carcinoma that have produced steroid hormones without endocrinological symptoms. Both men were admitted to hospital because of an abdominal pain and left hypochondral tumors. In each case, an abdominal CT, an ultrasonogram and an angiogram demonstrated a left adrenal tumor, and levels of blood dehydroepiandrosterone sulfate, etiocholanolone, pregnenolone sulfate and urine 17 KS were elevated. The tumors were resected and the histology revealed that they were adrenocortical carcinomas. Postoperatively, the levels of their urine hormones returned to normal values, though in one man recurrence occurred a year later. Only 8 cases of an adrenocortical carcinoma that has produced steroids without specific endocrinological symptoms have been reported in Japan, and we also report on two cases herein.

[A case of three malignant tumors of the duodenal bulb and large intestine]

A 75-year-old woman with anemia admitted to our hospital and was found to have a polyp in the duodenal bulb. The biopsy specimen was histologically diagnosed as an adenoma. A barium enema examination showed an obstruction in the ascending colon and a biopsy done on a specimen of the ascending colon revealed colonic cancer. A histology of the resected specimen of the duodenal bulb revealed a tubular adenocarcinoma in an adenoma, and a similar examination of a colonic resected specimen revealed a mucinous, papillary carcinoma. A primary malignant tumor in the duodenum is an uncommon tumor and our case is first in Japan showing three malignant tumors with an early duodenal cancer.

[von Recklinghausen's disease associated with pheochromocytoma--an autopsy case report and review of 24 cases in the Japanese literature]

A 56-year-old woman was admitted because of vomiting and right hypochondralgia. Since she was 25 years old, she had been sick with neurofibromatosis. Systemic neurofibromatosis with café-au-lait spots, blood hypertension and tenderness on the right hypochondrium were found. Ultrasonic examination revealed a right adrenal mass. Levels of serum catecholamines were elevated. She developed ileus and died of shock from the release of adrenal catecholamines. Postmortem examination showed right adrenal pheochromocytoma. The tumor measured 11.5 X 8 cm and weighed 25 gm. Von Recklinghausen's disease associated with pheochromocytoma is very rare, and only 24 cases have been reported in Japan. We present our case here with a review of the literature.

[The measurement of SCC antigen in squamous cell carcinoma of the lung]

Serum squamous cell carcinoma (SCC) antigen levels were measured in 55 patients with lung cancer, 43 with benign diseases and 50 normal subjects. At the same time, carcinoembryonic antigen (CEA) was measured for comparison. The mean SCC antigen levels were 1.47 + 0.50 ng/ml in 50 normal subjects. The percentage of positive case for SCC antigen (higher than 2.6 ng/ml) was 27.8% in lung cancer as a whole, 17.6% in adenocarcinoma, 47.6% in squamous cell carcinoma, 6.7% in small cell carcinoma and none in large cell carcinoma. Fifty percent of the Stage II patients were positive for SCC antigen, and the assay might be a possibility for early diagnosis. Our study suggests that SCC antigen assay may be a useful test for the identification and evaluation of lung cancer patients.

[Clinicopathological studies on disseminated carcinomatosis of the bone marrow occurring through metastasis of gastric carcinoma]

Five cases of gastric carcinoma (one woman) were investigated. The average age of the patients was 44 and the clinical manifestation were lumbago, melena and fatigue. Two cases were Borrmann III, and other were Borrmann IV, IIc and IIc advanced, respectively. Three were signet-ring cell carcinoma and the other two were moderately differentiated and well-differentiated adenocarcinoma, respectively. All patients showed leukoerythroblastosis. Bone marrow specimens revealed myelofibrosis in three cases, while adenocarcinoma cells were also found in three. MHA or DIC was found in three patients, all of whom died of bleeding tendency. Mean survival time was 2.6 months. Thus, bone marrow carcinomatosis proved to be very severe.

[The comparison of blood levels between peripheral vein and tooth extraction wound after the oral administration of antibiotics (author's transl)]

The oral administration of 300 mg of clindamycin was undertaken on 23 patients, of 500 mg of cefadroxil on 11 patients and of 250 mg of talampicillin on 12 patients, and then tooth extraction was performed under local anesthesia. Blood samples were taken from the extraction wound and the peripheral vein at the same time and assayed by the bioassay method. The blood levels of clindamycin and cefadroxil indicated a similar pattern between the extraction wound and the peripheral vein, but the blood level of talampicillin reached peek level rapider than clindamycin and cefadroxil. The blood levels of the extraction wound were 60 - 80% as compared with the venous blood levels with each antimicrobial agent.