Decreased plasma and cerebrospinal fluid glutamine concentrations in a patient with bialaphos poisoning

2001 ◽  
Vol 20 (8) ◽  
pp. 429-434 ◽  
Author(s):  
T Ohtake ◽  
H Yasuda ◽  
H Takahashi ◽  
T Goto ◽  
K Suzuki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Respiratory Arrest ◽  
Japanese Woman ◽  
Maintenance Hemodialysis ◽  
Loss Of Consciousness ◽  
Toxic Metabolite ◽  
Glutamine Concentration ◽  
Direct Hemoperfusion ◽  
Glutamate Concentration ◽  
Old Japanese

A 47-year-old Japanese woman undergoing maintenance hemodialysis (HD) was admitted to our hospital because of poisoning with the herbicide bialaphos. Respiratory arrest and loss of consciousness ensued rapidly, accompanied by convulsions and nystagmus. Treatment with HD and direct hemoperfusion, followed by HD alone, effectively removed bialaphos and its chief toxic metabolite (L-AMPB) from the circulation (bialaphos decreased from 0.33 to <0.05 g/ml andL-AMPBfrom14to0.86 g/ml). The glutamate concentration improved gradually after the removal of bialaphos and L-AMPB from plasma (plasma glutamate concentration: 250.4 nmol/l on day 5 to 120.6 nmol/l on day 26). Decreased glutamine concentration in cerebrospinal fluidwasdemonstratedforthefirsttimeaswellasinplasma, indicating glutaminesynthetase inhibition notonlyinplants but also in humans by bialaphos poisoning.

scholarly journals Reversible Ceftriaxone-Induced Pseudolithiasis in an Adult Patient with Maintenance Hemodialysis

2015 ◽  
Vol 5 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Aya Shima ◽  
Takaichi Suehiro ◽  
Misaki Takii ◽  
Hiroyasu Soeda ◽  
Makoto Hirakawa
Keyword(s):  
Renal Disease ◽  
Bacterial Infections ◽  
Gallbladder Wall ◽  
Generation Cephalosporin ◽  
Japanese Woman ◽  
Maintenance Hemodialysis ◽  
Clearance Mechanism ◽  
Old Japanese ◽  
Stage Renal Disease ◽  
End Stage

Ceftriaxone (CTRX) is a third-generation cephalosporin widely used for the treatment of bacterial infections in patients with renal disease because of its excretion by both renal and hepatic mechanisms. Biliary pseudolithiasis is a known CTRX-associated complication; however, there have been no studies of this adverse event in adult patients receiving maintenance hemodialysis. Here we report the case of a 79-year-old Japanese woman with end-stage renal disease (ESRD) receiving maintenance hemodialysis who developed CTRX-induced pseudolithiasis. The patient received CTRX for bronchial pneumonia. Fifteen days following CTRX initiation, the patient presented with stomachache. Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis. CTRX was discontinued immediately. At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved. ESRD may be a risk factor for CTRX-induced pseudolithiasis as hepatic excretion of CTRX is the predominant clearance mechanism in patients with ESRD. More attention should be paid to CTRX-induced pseudolithiasis following the use of CTRX in ESRD patients.

Cerebellitis in a human T-lymphotropic virus type 1 carrier: a case report

2021 ◽  
Vol 14 (6) ◽  
pp. e241366
Author(s):  
Atsushi Mizuma ◽  
Kumiko Enokida ◽  
Eiichiro Nagata ◽  
Shunya Takizawa
Keyword(s):  
Cerebrospinal Fluid ◽  
Virus Type ◽  
Spastic Paraparesis ◽  
Saccadic Eye Movements ◽  
Japanese Woman ◽  
High Dose ◽  
Type I ◽  
T Lymphotropic Virus ◽  
Word Finding ◽  
Old Japanese

Human T-lymphotropic virus type I (HTLV-I) is a retrovirus associated with adult T-cell lymphoma (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). In addition to HAM/TSP and ATL, HTLV-I-associated encephalopathy and cerebellar involvement have been reported. We report a case of an 87-year-old Japanese woman presenting with progressive dysarthria and gait disturbance. Neurological examination showed word-finding difficulty, scanning speech, saccadic eye movements, ocular dysmetria, gaze-evoked nystagmus and bilateral dysmetria. There was no motor weakness or spasticity. HTLV-I antibody was detected in both her serum and cerebrospinal fluid. Cerebrospinal fluid neopterin (57 pg/mL) and IgG index (3.27) were significantly elevated. MRI showed cerebellar swelling. She was finally diagnosed with HTLV-I associated cerebellitis. Two courses of high-dose intravenous methylpredonine therapy attenuated cerebellar ataxia and cerebellar swelling. It suggests that cerebellitis can result from HTLV-I infection, regardless of the existence of ATL or HAM/TSP.

Pharmacokinetics of Anticancer Drugs in Cerebrospinal Fluid

1998 ◽  
Vol 32 (10) ◽  
pp. 1008-1012 ◽  
Author(s):  
Norifumi Morikawa ◽  
Teruaki Mori ◽  
Hisanori Kawashima ◽  
Masaharu Takeyama ◽  
Shigeaki Hori
Keyword(s):  
Cerebrospinal Fluid ◽  
Anticancer Drugs ◽  
Spinal Canal ◽  
Japanese Woman ◽  
Fluorescence Polarization Immunoassay ◽  
Case Summary ◽  
Drug Concentrations ◽  
Old Japanese ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

OBJECTIVE: To examine the pharmacokinetics of anticancer drugs in the cerebrospinal fluid (CSF) during chemotherapy by the lumbar– ventricular (LV) and ventricular–lumbar (VL) routes. CASE SUMMARY: A 69-year-old Japanese woman with disseminated glioblastoma received two LV and four VL courses of CSF perfusion chemotherapy with methotrexate, nimustine, and cytarabine hydrochloride. Samples of CSF from the ventricles and lumbar spinal canal were obtained via Ommaya reservoirs during one LV and one VL course. Drug concentrations in the CSF were measured by fluorescence polarization immunoassay or HPLC. RESULTS: During LV CSF perfusion, the highest CSF drug concentrations in both the ventricles and the lumbar spinal canal were observed at the end of perfusion. During treatment, the concentrations of all three drugs in the lumbar spinal canal were higher than those in the ventricles. The CSF AUC of methotrexate in the ventricles was 16.1% of that in the lumbar spinal canal. During VL CSF perfusion, the highest drug concentrations were also observed at the end of perfusion. The drug concentrations in the lumbar spinal canal were initially lower than those in the ventricles. However, the concentrations of methotrexate and cytarabine in the lumbar spinal canal exceeded those in the ventricles 3 hours after perfusion. The AUC of methotrexate in the lumbar spinal canal was 174.9% of that in the ventricles. CONCLUSIONS: The pharmacokinetics of anticancer drugs in ventricular CSF differ from those in lumbar CSF during LV and VL perfusion chemotherapy.

Pharmacokinetics of Methotrexate in Plasma and Cerebrospinal Fluid

1997 ◽  
Vol 31 (10) ◽  
pp. 1153-1156 ◽  
Author(s):  
Norifumi Morikawa ◽  
Teruaki Mori ◽  
Tatsuya Abe ◽  
Makoto Ghoda ◽  
Masaharu Takeyama ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Brain Barrier ◽  
Combination Chemotherapy ◽  
Japanese Woman ◽  
Brain Barrier ◽  
Pharmacokinetic Parameters ◽  
Tumor Removal ◽  
Blood Brain ◽  
Old Japanese ◽  
The Right

OBJECTIVE: To investigate the pharmacokinetics of methotrexate (MTX) in plasma and cerebrospinal fluid (CSF) during osmotic disruption of the blood-brain barrier and the intraarterial administration of combination chemotherapy postoperatively in a patient with glioblastoma. CASE SUMMARY: A 60-year-old Japanese woman with a glioblastoma received two courses of combination intraarterial chemotherapy. In the first course of treatment, 20 mL of mannitol 20%, peplomycin 10 mg, vindesine 2 mg, and MTX 500 mg were administered via the right internal carotid artery, and then via the right vertebral artery. In the second course of treatment, 20 mL of mannitol 20%, peplomycin 15 mg, vindesine 2.5 mg, and MTX 1000 mg were similarly administered. Blood samples and CSF samples from the ventricle and the space left by tumor removal were obtained; the MTX concentrations were measured from these sites by fluorescence polarization immunoassay. The pharmacokinetic parameters of MTX in plasma and CSF were estimated. DISCUSSION: The plasma concentration of MTX decreased in a biexponential decay pattern during each course of treatment. CSF concentrations of MTX in the ventricle and in the space left by tumor removal peaked at 2 and 6 hours, respectively, after drug administration and decreased monoexponentially. When the dose of MTX was doubled, the AUC for the plasma MTX concentration increased 2.4-fold and the AUCs for MTX in the ventricle and the space left by tumor removal increased 3.4- and 9.1-fold, respectively. The half-life of MTX in the CSF in the space left by tumor removal exceeded the half-lives of MTX in the plasma and in the ventricular CSF. CONCLUSIONS: The CSF AUCs of MTX in the ventricle and the space left by tumor removal increased markedly and in parallel with the MTX dosage increase during osmotic disruption of the blood-brain barrier and intraarterial combination chemotherapy. Such treatment improves the delivery of chemotherapy agents to the brain.

scholarly journals Neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus

2012 ◽  
Vol 2 (1) ◽  
pp. 16
Author(s):  
Takeshi Kusunoki ◽  
Katsuhisa Ikeda
Keyword(s):  
Maxillary Sinus ◽  
Neuroendocrine Carcinoma ◽  
Past History ◽  
Japanese Woman ◽  
Old Japanese ◽  
Weighted Magnetic Resonance Imaging ◽  
Maxillary Cyst ◽  
Left Maxillary Sinus ◽  
Eye Movement Disorders ◽  
Cheek Swelling

We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc’s method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc’s method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis.

scholarly journals Severe infection including disseminated herpes zoster triggered by subclinical Cushing’s disease: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuki Yamauchi ◽  
Hiraku Kameda ◽  
Kazuno Omori ◽  
Michio Tani ◽  
Kyu Yong Cho ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Cushing’S Disease ◽  
Cardiopulmonary Arrest ◽  
Severe Infection ◽  
Japanese Woman ◽  
The Body ◽  
Cushing's Disease ◽  
Old Japanese ◽  
Subclinical Cushing’S Disease ◽  
Physical Features

Abstract Background Subclinical Cushing’s disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing’s disease. Infection is an important complication associated with mortality in Cushing’s disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome. Case presentation An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ. Conclusions As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.

scholarly journals Conservatively Treated Femoral Intertrochanteric Fracture With Early Asymptomatic Novel Coronavirus Disease 2019 (COVID-19): A Case Report

2020 ◽  
Vol 11 ◽  
pp. 215145932096938
Author(s):  
Yuki Suzuki ◽  
Toshihiko Kasashima ◽  
Kazutoshi Hontani ◽  
Yasuhiro Yamamoto ◽  
Kanako Ito ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Screening Method ◽  
Oxygen Demand ◽  
Japanese Woman ◽  
Trauma Patients ◽  
Lung Field ◽  
Old Japanese ◽  
Femoral Intertrochanteric Fracture ◽  
Novel Coronavirus ◽  
The Right

Introduction: The ongoing outbreak of novel coronavirus disease 2019 (COVID-19) is a worldwide problem. Although diagnosing COVID-19 in fracture patients is important for selecting treatment, diagnosing early asymptomatic COVID-19 is difficult. We describe herein a rare case of femoral intertrochanteric fracture concomitant with early asymptomatic novel COVID-19. Case presentation: An 87-year-old Japanese woman was transferred to our emergency room with a right hip pain after she fell. She had no fever, fatigue, or respiratory symptoms on admission and within the 14 days before presenting to our hospital, and no specific shadow was detected in chest X-ray. However, chest computed tomography (CT) was performed considering COVID-19 pandemic, and showed ground-glass opacities with consolidation in the dorsal segment of the right lower lung field. Then, qualitative real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was carried out and turned out to be positive. She was diagnosed right femoral intertrochanteric fracture with concomitant COVID-19 infection. Conservative treatment was applied to the fracture due to infection. After admission, fever and oxygen demand occurred but she recovered from COVID-19. Throughout the treatment period, no cross-infection from the patient was identified in our hospital. Conclusion: This case highlights the importance of considering chest CT as an effective screening method for infection on hospital admission in COVID-19-affected areas, especially in trauma patients with early asymptomatic novel COVID-19.

Rapid Deterioration of Latent HBV Hepatitis during Cushing Disease and Posttraumatic Stress Disorder after Earthquake

2017 ◽  
Vol 78 (04) ◽  
pp. 407-411 ◽  
Author(s):  
Ryosuke Tashiro ◽  
Teiji Tominaga ◽  
Yoshikazu Ogawa
Keyword(s):  
Hepatic Dysfunction ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Japanese Woman ◽  
Hbv Reactivation ◽  
Cushing Disease ◽  
Old Japanese ◽  
Threatening Condition ◽  
The Right ◽  
Subtotal Removal

AbstractReactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation.We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course.Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.

scholarly journals Cerebral Gas Embolism in the Course of Mildly Symptomatic Pulmonary Barotrauma in a Scuba Diver

2020 ◽  
Vol 71 (2) ◽  
pp. 41-44
Author(s):  
Brunon Kierznikowicz ◽  
Stefan Teresiński
Keyword(s):  
Nervous System ◽  
Complete Remission ◽  
Respiratory Arrest ◽  
Loss Of Consciousness ◽  
Scuba Diver ◽  
Gas Embolism ◽  
Trauma Symptoms ◽  
Pulmonary Barotrauma ◽  
Hyperbaric Treatment ◽  
Seizure Episode

Abstract The paper presents a case of pulmonary barotrauma in a scuba diver. Swallowing water and respiratory arrest during the ascent caused the trauma. Symptoms from the respiratory system (including the Behnke’s symptom) appeared several minutes after the completion of the dive and were not severe. However, symptoms from the peripheral nervous system, which appeared later, increased rapidly until the seizure episode and loss of consciousness. Hyperbaric treatment was applied in a decompression chamber on board the ship from which the dive was conducted. The treatment resulted in complete remission of symptoms without any consequences.

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