Role of surgery in the comprehensive treatment of epilepsies: introduction and summary.
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Epilepsy↗
Biomedical subjects
A Sengoku
Publications and source records attributed to A Sengoku.
[Two cases of renal cell carcinoma accompanied with ossification].
We report two cases of renal cell carcinoma accompanied with ossification. Case 1: A 40-year-old male visited a physician with the complaint of epigastric pain. Examination of the stomach revealed compression of the greater curvature. Abdominal radiography and CT scan revealed a left renal mass with calcification, which was a hypovascular tumor on angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 700g in weight and the tumor, which was 12 x 10 x 10 cm in size and located in the upper pole of the kidney, was enveloped with a hard capsule and was extensively necrotized. Histopathological diagnosis was renal cell carcinoma (papillary type, mixed subtype). Case 2: A 69-year-old female was occasionally pointed out to have a left renal mass in ultrasonic examination. It was accompanied with calcification in CT scan and a hypervascular tumor in angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 320 g in weight and the tumor located in the lower pole of the kidney, was 6 x 6 x 6 cm in size and necrotized. Histopathological diagnosis was renal cell carcinoma (alveolar type, clear cell subtype). Microscopically in both cases, ossified tissue existed among the fibrous tissue in the necrotized lesion of the tumor, but not near the cancer cells and, it was accompanied by calcification. During the ossification process, the connective tissue proliferates after the necrosis of the tumor, and metaplasia occurred from its juvenile plastic cells to osteoblastic cells.
Adult↗
[Two cases of renal oncocytoma].
Two cases of renal oncocytoma are reviewed. A 67-year-old man and a 21-year-old man with a right renal mass were incidentally revealed by echography. Selective renal angiogram showed no spoke-wheel configuration of vessels in either case. Both cases were pathologically diagnosed as oncocytomas, constructed of large eosinophilic cells with granular cytoplasm and small regular nuclei. The electron micrograph showed cytoplasm packed abundantly with mitochondria. The two patients are in good condition 2.5 and 1.5 years after diagnosis.
Adenoma↗
[A study on the treatment duration of an antibacterial agent in complicated urinary tract infections. Utility and recurrence after 14-day treatment by fleroxacin].
In this study, fleroxacin (FLRX), a new quinolone derivative, was orally given at 300 mg once daily for 14 days to 102 patients with non-catheterized complicated urinary tract infections in order to determine the optimal treatment duration. We investigated its efficacy at day 5-7 and day 14, according to the criteria proposed by the Japanese UTI Committee, and also to the recurrence rate after the withdrawal. The results were as follows: 1. Overall clinical efficacy rates were 86% at day 5-7 and 84% at day 14. Both incidence of bacterial replacement in bacteriuria and normalization in pyuria were increased at day 14 as compared with those at day 5-7. 2. Bacteriological eradication rates were 91% at day 5-7 and 89% at day 14. 3. Clinical efficacy rates from physicians' evaluation were 86% at day 5-7 and 88% at day 14. 4. Incidence of side effects was 9.1%, and most of the cases were gastrointestinal symptoms which appeared within 4 days. Slight and transitory changes in laboratory findings were noted in 2.3% of evaluable cases. 5. With the occurrence of pyuria and bacteriuria as markers, the "no recurrence" rates were 63% at 1 week, 54% at 2 weeks, 61% at 3 weeks, 81% at 4-6 weeks after the withdrawal, and the "recurrence" rates were 4%, 4%, 6% and 5%, respectively. Remaining cases were judged as "reserved assessment". Generally, aggravation of bacteriuria was found but the aggravation of pyuria was observed in only few cases. 6. According to breakdown of cases with bacteriuria only, cure rate was 67% and recurrence rate was 33%. Re-infections were observed much more frequently than relapse based on the identification of infecting organisms. These results suggest that sufficient bacteriological eradication and clinical efficacy could be obtained by 14-day treatment of FLRX in non-catheterized complicated urinary tract infections. The efficacy of the treatment became evident around day 7. In approximately 30% of the cases in which eradication of the initial causative organisms was observed at day 14 reappearance of bacteriuria (greater than or equal to 10(3) CFU/ml) occurred after withdrawal of the antibiotic, but cases with pyuria were few, and the incidence of true recurrence was generally low. Onset of side effect after 5-day was not seen, hence FLRX seemed to be a safe agent.
Administration, Oral↗
[A case of Fournier's gangrene: was it triggered by prostatic massage?].
We have experienced a case of Fournier's gangrene which progressed rapidly after prostatic massage. The patient was a 70-year-old man who had poorly controlled diabetes mellitus, hemorrhoid, urethral stricture and benign prostatic hyperplasia. He visited an urologist complaining of pollakisuria and miction pain. Under the diagnosis of prostatitis, prostatic massage was performed. From that night, he developed a high grade fever. Simultaneously, redness, swelling and pain of the scrotum progressed rapidly, and 11 days later, he was admitted to our hospital. An X-ray examination revealed subcutaneous gas formation in the scrotum. Immediately, incision and drainage with extensive debridement of necrotic tissue were performed combined with chemotherapy using broad spectrum antibiotics and insulin therapy. About 3 months later, the gangrene and the wound were healed with granulation and scarring. Cultures of the pus and the necrotic tissue from the scrotum were positive for Bacteroides fragilis and several aerobes including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus and Staphylococcus epidermidis. The case proved to be non-clostridial gas gangrene.
Aged↗
Traumatic dislocation of the testis: a case report.
We report a case of a traumatic dislocation of the testis in a 17-year-old male. He noticed lack of right scrotal contents three months after a motorcycle accident. The right testis, located at the inguinal subcutaneous region, was surgically replaced into the scrotum. The biopsy specimen of the dislocated testis showed partial atrophy of the seminiferous tubules that resulted in impaired spermatogenesis. Our case represents the 57th case of traumatic dislocation of the testis reported in Japan.
Accidents, Traffic↗
Dynamic EEG topography in epileptic seizures.
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Adolescent↗
Cognitive function during absence seizures.
One patient with frequent spike-waves in EEG was studied by a neuropsychological test. The spike-waves caused an obvious prolongation of cognitive processing. This delay was considered to be caused not only by motor inhibition but also by impaired cognitive function.
Adolescent↗
Treatment of childhood epilepsy with rectal valproate: case reports and pharmacokinetic study.
Two children with status epilepticus were treated successfully by the rectal administration of valproate (VPA), and complete seizure control was obtained in one patient without severe side effects. In addition, there was no essential difference in pharmacokinetics between rectal and oral administration of VPA as determined by computerized simulation of plasma concentration data of VPA after rectal administration in two healthy adults or an epileptic child. Although these findings suggest that the early absorption of VPA within 30 minutes of rectal administration is slightly more rapid than that of oral administration, rectal VPA seems to be unsuitable for the first choice in the treatment of status epilepticus, since it has not so immediate effects as intravenous administration of DZP.
Administration, Rectal↗
Episodic psychotic states in temporal lobe epilepsy: an investigation on their physiopathogenesis.
The discussion here is about the direct relationship of epileptic seizures to episodic psychotic states. The episodic psychotic states were divided into three groups: interictal, ictal and postictal. In each group, one representative case was described and the neurophysiological pathogenesis discussed according to a recent research, mainly depth-electrode findings. It is believed that: interictal psychotic state--limbic paroxysmal discharges play an important role in its pathogenesis, according to the theory of Geschwindt and others; ictal psychotic state--repetitive auras develop to the psychotic state, and aura continua itself can be described as a psychotic state; and postictal psychotic state--the increased limbic discharges might be responsible for the psychotic state. The common neurophysiological cause in all the three groups is due to the increased epileptic discharges in the limbic system. It is concluded that the episodic psychotic states in temporal lobe epilepsies are possibly of an epileptic nature in themselves.
Adolescent↗
Risks of occurrence of psychoses in relation to the types of epilepsies and epileptic seizures.
The possible existence of the risks of occurrence of psychoses was examined in relation to the types of epilepsies and epileptic seizures. This study consisted of two investigations: 1) A study of 879 epileptic patients was conducted in which the incidence of psychoses in the different types of epilepsies was surveyed; the result was that the incidence in temporal lobe epilepsy was the highest, being relatively higher than that of other (non-temporal lobe) partial epilepsies but not significantly different from that of generalized epilepsies. 2) A comparative study was carried out on 96 patients with temporal lobe epilepsy in which 48 were psychotic and another 48 were non-psychotic which served as a control group. The differences of seizure symptomatology between the two groups were compared. The results were that the psychotic group was found to exhibit at a significantly higher rate generalized tonic-clonic convulsion and compound seizure manifestations in comparison with the non-psychotic group. The results appear to support the fact that generalizing mechanisms of temporal lobe epileptic manifestations are closely related to a physiopathogenic factor influencing psychoses.
Adolescent↗
On the Lennox syndrome with the onset in puberty.
The cases of the Lennox syndrome which began at the age between 14 and 16, namely in puberty, were reported. The first case, a 22-year-old woman, was attacked with grand mal seizure at the age of 15, and one year later "Juchzer" (ref. Doose) appeared. This continued for two years, and then astatic seizures appeared. The second case, a 20-year-old woman, was attacked with grand mal seizure at the age of 14, and soon after astatic seizure appeared. Thus both are closely related with grand mal seizures. The first case is idiopathic, and the intelligence developed normally till the onset of the Lennox syndrome. but after that it became disturbed. The second case is residual state of arsenic toxicosis, and so the intelligence was already disturbed before the onset. On EEG both of them at first showed diffuse slow waves of high voltage, and in several years after the appearance of the Lennox syndrome, slow spike-waves were found. On therapy, scarcely no beneficial effects were noted by conventional antiepileptics, and by nitrazepam only the temporal beneficial effect was obtained. The symptoms of our cases are generally similar to the Lennox syndrome in infancy. Though we observed only two cases, we presented our cases as the Lennox syndrome with late onset.
Adult↗
[Lennox syndrome with the late onset in puberty].
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Adult↗
Oculoclonic status epilepticus.
Continuous oculoclonic status epilepticus occurred for 90 min in a 4-year-old girl. The seizure consisted of continuous contralateral horizontal nystagmus concurrent with left occipital spike discharges, occasional vomiting and no loss of consciousness. Oculoclonic status epilepticus may be a variant form of versive status epilepticus.
Anticonvulsants↗
Visual cognitive disturbance during spike-wave discharges.
Cognitive functions of patients showing slow spike-wave discharge in EEG without obvious absence seizures were investigated using tachistoscopic stimuli triggered by spike-waves. Response times obtained during spike-waves and during non-spike-waves were compared for three tests (tapping, simple reaction, and morphological discrimination). We present one case of Lennox-Gastaut syndrome in which the test results could be statistically confirmed. The tapping test was interrupted by the occurrence of spike-waves. Response times during spike-waves were more delayed than during non-spike-waves in both the simple reaction tests and morphological discrimination tests. The differences in response times measured during spike-waves and during non-spike-waves were significantly greater in the morphological discrimination test than in the simple reaction test. The positive correlation between the length of spike-waves and response time in the discrimination test was significantly more pronounced than in the reaction test. These results were also confirmed in two other patients with Lennox-Gastaut syndrome. We conclude that spike-wave discharges may impair cognitive processing more intrinsically than motor functions.
Adolescent↗