Effect of adrenocorticotropic hormone therapy for epileptic spasms developing after the age of 1 year

AbstractPurposeEpileptic spasms sometimes begin after the first year of life, and such seizures are recognized as late-onset spasms (LOS). The prognosis of LOS is poor, and a treatment strategy has not been established. This study aimed to assess the short- and long-term effects of adrenocorticotropic hormone (ACTH) therapy for LOS.MethodsWe investigated the rate of LOS in 22 patients (14 boys and 8 girls) treated with ACTH therapy. The age at onset of LOS and at the start of ACTH therapy ranged from 12 to 94 months (median, 31.6±22.1 months) and from 12.5 to 116 months (median, 37.5±23.7 months), respectively. We investigated the response rate of LOS treated with ACTH therapy, and compared the clinical features between responders (short-term) and nonresponders.ResultsNine (41%) of the 22 patients showed cessation of epileptic spasms within 3 months. The epileptic spasms ceased in four of these nine patients for more than 1 year. The age at onset of LOS was significantly associated with short-term seizure cessation (p<0.05). Patients who achieved short-term cessation of seizures received ACTH therapy within 6 months from the onset of LOS.ConclusionACTH therapy is a potentially effective treatment when started within 6 months from the onset of LOS. A younger age at onset of LOS is associated with a favorable outcome

開胸開腹食道切除術後に発生した横隔膜ヘルニアの1例

食道癌術後3日目に横行結腸が嵌頓した食道裂孔ヘルニアの1例を経験したので報告する.症例は75歳,女性.2型の胸部中部食道癌に対して右開胸開腹胸部食道亜全摘術,胸腔内食道胃管吻合術を施行したが,術後3日目に突然の呼吸困難を呈した.胸腹部単純X線上,縦隔内に巨大な大腸ガス像を認め,大腸を内容とした食道裂孔ヘルニアと診断し,同日緊急開腹術を施行した.食道裂孔の左側より横行結腸が縦隔内に脱出し,裂孔部で嵌頓していた.ヘルニア内容を腹腔に還納し,食道裂孔の縫縮とメッシュによる補強を行った.術後経過は比較的良好で,術後36日目に軽快転院となった.食道癌術後の食道裂孔ヘルニアはきわめてまれな合併症であるが,その治療として食道裂孔の縫縮およびメッシュによる補強が有用であった.A 75-year-old woman underwent an esophagectomy for thoracic esophageal cancer via right thoracic and abdominal incisions. After resection, the gastric tube was pulled into the posterior mediastinum and intrathoracic esophagogastric anastomosis was performed. Her postoperative course was uneventful until the oxygen saturation decreased to 88% along with the sudden onset of dyspnea on the third postoperative day. A plain chest X-ray demonstrated gas extending from the posterior mediastinum to the left lower hemithorax. As a result, a diagnosis of diaphragmatic herniation of large bowel was made and an emergency laparotomy was performed. After reducing the herniated transverse colon, the enlarged esophageal hiatus was repaired with interrupted sutures and a sheet of Merlex mesh. The patient subsequently recovered well and was discharged on the 36th postoperative day

Actions of Probiotics on Trinitrobenzenesulfonic Acid-Induced Colitis in Rats

We investigated the actions of probiotics, Streptococcus faecalis 129 BIO 3B (SF3B), in a trinitrobenzenesulfonic acid- (TNBS-) induced colitis model in rats. After TNBS was administered into the colons of rats for induction of colitis, the rats were divided into two groups: one group was given a control diet and the other group was given a diet containing SF3B for 14 days. There were no apparent differences in body weight, diarrhea period, macroscopic colitis score, and colonic weight/length ratio between the control group and SF3B group, suggesting that induction of colitis was not prevented by SF3B. Next, we investigated whether SF3B-containing diet intake affects the restoration of enteric neurotransmissions being damaged during induction of colitis by TNBS using isolated colonic preparations. Recovery of the nitrergic component was greater in the SF3B group than in the control group. A compensatory appearance of nontachykininergic and noncholinergic excitatory components was less in the SF3B group than in the control group. In conclusion, the present study suggests that SF3B-containing diet intake can partially prevent disruptions of enteric neurotransmissions induced after onset of TNBS-induced colitis, suggesting that SF3B has therapeutic potential

開胸開腹食道切除術後に発生した横隔膜ヘルニアの1例

食道癌術後3日目に横行結腸が嵌頓した食道裂孔ヘルニアの1例を経験したので報告する.症例は75歳,女性.2型の胸部中部食道癌に対して右開胸開腹胸部食道亜全摘術,胸腔内食道胃管吻合術を施行したが,術後3日目に突然の呼吸困難を呈した.胸腹部単純X線上,縦隔内に巨大な大腸ガス像を認め,大腸を内容とした食道裂孔ヘルニアと診断し,同日緊急開腹術を施行した.食道裂孔の左側より横行結腸が縦隔内に脱出し,裂孔部で嵌頓していた.ヘルニア内容を腹腔に還納し,食道裂孔の縫縮とメッシュによる補強を行った.術後経過は比較的良好で,術後36日目に軽快転院となった.食道癌術後の食道裂孔ヘルニアはきわめてまれな合併症であるが,その治療として食道裂孔の縫縮およびメッシュによる補強が有用であった.A 75-year-old woman underwent an esophagectomy for thoracic esophageal cancer via right thoracic and abdominal incisions. After resection, the gastric tube was pulled into the posterior mediastinum and intrathoracic esophagogastric anastomosis was performed. Her postoperative course was uneventful until the oxygen saturation decreased to 88% along with the sudden onset of dyspnea on the third postoperative day. A plain chest X-ray demonstrated gas extending from the posterior mediastinum to the left lower hemithorax. As a result, a diagnosis of diaphragmatic herniation of large bowel was made and an emergency laparotomy was performed. After reducing the herniated transverse colon, the enlarged esophageal hiatus was repaired with interrupted sutures and a sheet of Merlex mesh. The patient subsequently recovered well and was discharged on the 36th postoperative day