Internal medicine
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We present a 76-year-old man with cryptogenic new-onset refractory status epilepticus (C-NORSE) with an initial abnormal signal in the nucleus accumbens and a remarkable hyperintense signal on T1-weighted magnetic resonance imaging in the bilateral basal ganglia (BG). His status epilepticus did not respond to most anti-epileptic therapies or immunotherapies, and he died of sepsis. An autopsy revealed severe neuronal loss and hypertrophic astrocytes in the BG and limbic system, with no signs of inflammation or malignancy. This case suggests that lesions in the BG may reflect secondary degeneration and predict poor outcomes in C-NORSE.
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Objective The mean platelet volume (MPV), a marker of platelet activity, is significantly higher in patients with aortic stenosis (AS) than in those without AS. The association between the platelet function and prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains unknown. Therefore, we investigated this association by measuring the MPV. ⋯ A logistic regression analysis revealed that a higher MPV and lack of MPV reduction at the six-month follow-up were independent predictors of PPM. Conclusion MPV values at the six-month follow-up were associated with PPM after TAVR in patients with AS. MPV values increase when PPM is present after TAVR and may be an indicator during the postoperative follow-up.
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Introduction Short-term levodopa-carbidopa intestinal gel (LCIG) treatment using nasojejunal (NJ) tubes (NJ-LCIG test) is recommended for patients with advanced Parkinson's disease to ensure compatibility with this treatment system prior to permanent percutaneous endoscopic gastrojejunostomy. However, there have been no studies on NJ tube insertion by neurologists or on possible differences in treatment efficacy based on the NJ tube insertion method or tube tip position. We therefore investigated the effects of LCIG with NJ tube placement performed by a neurologist. ⋯ The off time decreased significantly after the NJ-LCIG test (pre-NJ-LCIG test, 6.6 h [5.1-8.1] vs. post-NJ-LCIG test, 2.0 h [0.8-3.5], p<0.01). There was no difference in effectiveness based on the site of NJ tube tip placement. Conclusion Our results suggest that neurologists can place NJ tubes and that the NJ-LCIG test can also improve off-time, regardless of the placement site.
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Background Gangliocytic paraganglioma (GP) significantly affects patients' quality of life. However, studies on endoscopic papillectomy (EP) for ampullary GP are limited. We therefore evaluated the safety and efficacy of EP for treating ampullary GP. ⋯ There was no disease recurrence or death. Conclusion EP led to good long-term outcomes and effectively treated ampullary GP. Considering the potential for lymph node metastasis, additional surgery is recommended if the tumor exceeds the submucosal layer.