Effect of bihemispheric transcranial direct current stimulation on distal upper limb function and corticospinal tract excitability in a patient with subacute stroke: a case study

IntroductionActivation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke.MethodsIn this single-case retrospective study, the Fugl–Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15–30 Hz, which reflects corticospinal tract excitability.ResultsThe results indicated that bihemispheric tDCS improved the Fugl–Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke

Endoscopic submucosal dissection of a minute intramucosal adenocarcinoma in Barrett\u27s esophagus.

A 73-year-old man with short segmental Barrett\u27s esophagus underwent esophagoscopy, and a slightly depressed, discolored lesion was found on the anterior wall of the lower esophagus. Under a provisional diagnosis of differentiated adenocarcinoma without local lymph node metastasis, endoscopic submucosal dissection (ESD) was carried out. En bloc resection with tumor-free lateral/basal margins was accomplished without complication. The resected area was 12 x 15 mm in size, whereas the neoplastic lesion was 4 x 4 mm. Histopathological examination confirmed intramucosal well-differentiated tubular adenocarcinoma without angiolymphatic invasion adjacent to the muscularis mucosae. Repeated esophagoscopy 6 months after ESD showed neither locally recurrent nor metachronous lesions. Considering that Barrett\u27s esophagus is a precancerous condition, one may recommend eradication of both the neoplastic and non-neoplastic lesion with using ESD.Without Figure

A Case of Autoimmune Hepatitis Associated with Idiopathic Thrombocytopenic Purpura and Chronic Thyroiditis

Autoimmune hepatitis (AIH) is frequently associated with extrahepatic autoimmune disorders such as rheumatoid arthritis, Sjogren\u27s syndrome, and chronic thyroiditis, but the association with idiopathic (immune) thrombocytopenic purpura (ITP) is rare. We report a 46-year-old Japanese woman who presented with severe thrombocytopenia, elevated levels of aminotransferases, immunoglobulin (Ig) G, and platelet-associated IgG (PAIgG), positive anti-nuclear antibody, and hypothyroidism. After a diagnosis of coexisting AIH, ITP, and chronic thyroiditis, the patient was treated with 30 mg/day of prednisolone orally. The patient responded to such treatment: showing an increase in the number of platelets and decrease of serum levels of aminotransferases, IgG, and PAIgG to within normal ranges. Discrimination of ITP from liver cirrhosis as a cause of severe thrombocytopenia seen in chronic liver disease is important because complications and therapy are quite different. Prednisolone as a treatment for All should be also effective for ITP, and therefore, ITP should be considered when liver dysfunction is accompanied by severe thrombocytopenia, particularly in the autoimmune types of liver diseases

Endoscopic Polypectomy of Esophageal Leiomyomas; Report of Two Cases

We describe esophageal leiomyomas in two young patients (aged 35 and 32 years), who complained of dysphagia and epigastralgia, which were successfully treated by endoscopic polypectomy. Upper endoscopy showed a pedunculated polyp beneath the normal mucosa located at 28 cm from the incisor in the first case and 1 cm sessile 2.1 cm semipedunculated polypoid lesion in the lower esophagus just above the esophageal-gastric junction in the second case. Both lesions were resected by snare polypectomy without any complication. Light microscopic examination and immunohistochemistry of the tumor tissue confirmed the diagnosis of leiomyoma. Endoscopic polypectomy of esophageal leiomyoma is safe and should be considered as an optional treatment modality whenever possible

Response to Urinary Trypsin Inhibitor Therapy in Ulcerative Colitis is Associated With a Decrease in Mast Cell Count in the Colonic Mucosa

BACKGROUND: Urinary trypsin inhibitor (UTI, ulinastatin (R)) inhibits proteinases and has been used for the treatment of ulcerative colitis (UC). We investigated the therapeutic effect of UTI in patients with UC and correlated this effect to mast cell (MC) and macrophages (M) counts in the colonic mucosal wall. DESIGN: Patients with UC resistant to corticosteroids (n=16) and normal control subjects (n=10) were included in this study. Biopsy specimens obtained from the sigmoid colon of patients before and after UTI therapy were immunostained with antibodies to tryptase (AA1, MC) and CD68 (M). The number of MC and M in the lamina propria (LP) was determined and expressed per mm2 of LP. RESULTS: Nine patients with UC responded to UTI treatment. The mean number of MC in the upper part of LP in responders(440ﾂｱ51/mm2)was higher than nonresponders (312ﾂｱ76/mm2)and normal controls(200ﾂｱ47/mm2). MC counts in the lower part of the LP were not different in responders and nonresponders, although the counts in both groups were significantly higher than control. The number of M in the lower part of LP was similar in responders and nonresponders, but were higher than control subjects. M counts in the upper part of LP were similar in both groups of patients and control. Effective treatment with UTI in responders was associated with a significant fall in the number of MC in the upper layer of LP but not in M. CONCLUSION. Our results showed that UTI is an effective therapy in steroid-resistant UC. Our results also showed effective therapy with UTI was associated with a reduction in MC counts in the colonic mucosa, suggesting that the control of these cells may mediate, at least in part, the therapeutic effects of UTI in UC

Spontaneous Regression of Colonic Lesions in Adult T-cell Leukemia

A 74-year-old man was admitted to our hospital because of diarrhea. Serum anti-HTLV-1 antibody was positive without abnormal lymphocytes. Colonoscopy demonstrated a edematous and congested mucosa with erosions, and ulcers in the region extending from the cecum to rectum. Biopsy specimens showed diffuse infiltration of abnormal lymphocytes positive for T-cell markers in the lamina propria. Conservative therapy was provided but no chemotherapy because of improvement of diarrhea within two weeks. A repeat colonoscopy 6 months later revealed scars without erosions or ulcers. Eight months after first admission, the patient was readmitted to our hospital because of acute ATL crisis, and died of hepatic involvement 7 days later. Colonic lesions associated with ATLS may show spontaneous regression and recurrence

Adenocarcinoma of the Small Intestine in a Young Adult Diagnosed by Double-balloon Enteroscopy

A 29-year-old man presented with a 3-month history of abdominal pain and appetite loss. Superficial lymph node adenopathy was noted. Systemic computed tomography showed multiple liver and lung metastases, as well as ascites. No abnormalities were found on upper gastrointestinal endoscopy and colonoscopy; therefore, double-balloon enteroscopy was performed. A stenosis with reddish and edematous mucosal changes from the third part of the duodenum to the upper jejunum was noted; on histopathology of the biopsy specimens, adenocarcinoma was diagnosed. Thus, the patient had advanced small intestinal cancer with carcinomatous peritonitis and liver metastases. Although the patient was given chemotherapy with cisplatin and 5-fluorouracil, he died 2 months after commencing treatment. Primary small intestinal carcinoma is a rare malignancy; most cases cannot be detected on routine gastrointestinal endoscopy due to their location. Our experience suggests that double-balloon enteroscopy is useful for diagnosing small intestinal adenocarcinoma