stones ; Right and left ; Kidney Failure

In the future, we will have more aged patients, more cases of bilateral total hip arthroplasty (THA) and more cases of bilateral revision THA. There are not, however, many reports of long-term follow-up of bilateral revision THA. We report a case of bilateral revision THA followed up for 11 years. A 74-year-old woman presented with bilateral painful hip in 1996. She had undergone left THA in 1984 and right THA in 1986 at another hospital. Her JOA(Japan Orthopaedic Association) scores on her first visit (right/left) were 32 points/31 points. Plain radiographs revealed a clear zone in her bilateral proximal femur. We diagnosed her as having looseness of bilateral THA. She required bilateral revision THA and underwent left revision THA (Charnley) in January 1997 (14 years after the original operation) and right revision THA (Charnley) in July 1997 (12 years after the original operation). After bilateral revision THA, we were able to follow up this patient for 11 years. She had no complaints about her bilateral hip joints, and X-ray examination showed no looseness. The JOA scores and range of motion illustrate the good result achieved for this case.
Right and left ; Tacrine ; Hip ; Arthroplasty ; Serotype eleven

We report here a rare case of bilateral pure gonadoblastoma which accounts for only 0.2% of all ovarian tumours seen at Universiti Kebangsaan Malaysia from 1980 to 1987. This tumour occurred in an 18 year old Chinese "female" who presented with primary amenorrhoea. Examination showed a phenotypic female with poorly developed external gentalia. Exploratory laparotomy revealed a hypoplastic uterus, rudimentary fallopian tubes and streak gonads. Histological examination of the gonads showed a mixed tumour comprising large germ cells and smaller sex cord derivatives arranged in characteristic nests or islands containing hyaline material.
Right and left ; Gonadoblastoma ; Gonads ; Female ; Case Report

A reappraisal was made with respect to a classical observation of the mode of instrumental phase reversals on inter-ictal EEG of seemingly bilateral synchronous spike-wave discharges in patients with either idiopathic generalized epilepsies (IGE) or symptomatic localization-related frontal lobe epilepsies (FLE). It was pointed out in the original observation by Tukel and Jasper that one phase reversal at midline or near the midline on the side of the parasagittal epileptogenic lesion designated as secondary bilateral synchrony (SBS) was found in patients with frontal lobe epilepsy (FLE), whereas a double phase reversal was found over the homologous frontal electrodes (F3 and F4) designated as primary bilateral synchrony (PBS) in patients with IGE. Twenty-three patients (IGE: 15, and FLE: 8) revealing bursts of seemingly bisynchronous spike-wave discharges in interictal EEGs were retrospectively studied. Discharge patterns were defined as stable phase reversal pattern if the site of phase-reversal was consistent, and as unstable pattern if the site of phase-reversal was not consistent but shifting in the same patient. Stable one phase-reversal pattern was found more frequently in FLE (50%) than in IGE patients (26.7%), and stable double phase-reversal pattern more frequently in the IGE (33.3%) than in the FLE group (12.5%). Notably, unstable pattern was found almost equally in both IGE and FLE patients (40% and 37.5%, respectively). Recognition of SBS or PBS in accordance with original observation was found not to clearly differentiate FLE from IGE in patients showing seemingly bisynchronous spike-wave complexes. The variability of instrumental phase-reversals can be accounted for by the fact that the localization of maxima of negative spike of the spike-and-wave complexes varies considerably.
IgE ; Pattern ; Right and left ; wave ; Patient observation

Authors evaluated the electrocardiographic criteria of Minnesota Code (III-1, III-2) for the diagnosis of left and right ventricular hypertrophy in 93 cases of healthy peoples, 74 cases of left ventricular hypertrophy and 4 cases of right ventricular hypertrophy and following results were obtained. 1. By left ventricular hypertropy criteria (III-1), there were 5.4% of false positive and 14.9% of false negative cases. 2. By right ventricular hypertrophy criteria III-2), there were 24.7% of false positive and 20.0% of false negative cases. 3. Electrocardiographic diagnosis of ventricular hypertrophy by Minnesota Code (III-1, III-2) were more reliable criteria than many other criteria of ventricular hypertrophy.
Diagnosis* ; Electrocardiography ; Hypertrophy* ; Hypertrophy, Left Ventricular ; Hypertrophy, Right Ventricular ; Minnesota*

Tubo-ovarian abscess (TOA) requires admission to hospital, i.v. antibiotics and, possibly, aspiration or surgery. A 35-year-old woman who was G2P1 was brought into the emergency department because of acute abdomen. A transvaginal ultrasonography demonstrated bilateral cystic adnexal tumors and a moderate amount of ascites suspected to be puss. Laparoscopic examination revealed that the left and right adnexa each formed an inflammatory mass. The left and right tubo-ovarian abscesses both formed masses, and the ovaries were indistinguishable from the tubes and other inflammatory tissues. Laparoscopic bilateral salpingo-oophorectomy was indispensable. Bacterial culture showed no bacterial growth. Performance of laparoscopic bilateral salpingo-oophorectomy was indispensable due to bilateral tubo-ovarian abscesses in this patient.
Right and left ; Laparoscopic ; Young ; Ovarian ; Human adult females

We report on three elderly patients with stroke-like onset of atypical Miller Fisher syndrome (MFS). The serum titer of anti-GQ1b IgG was markedly elevated in these patients. Their prognoses were sufficiently good with immunoadsorption therapy with or without intravenous immune globulin (IVIg) therapy. However, some neurological findings were not characteristic of typical MFS. Patient 1 suffered from prolonged dysesthesia in her left extremities, and Patients 2 and 3 showed no ataxia. Moreover, complete bilateral gaze limitation is rare in MFS. The sudden stroke-like onset along with the gaze limitation of these patients suggests that the unexpected elevation in the serum titer of anti-GQ1b IgG due to unknown immune dysregulation might have severely affected the third, fourth, and sixth nerves and this potent antibody rapidly attacked these nerves and induced stroke-like clinical features and complete ophthalmoplegia.
Cerebrovascular accident ; Miller Fisher Syndrome ; Right and left ; Serum ; Atypical

We treated a case with bilateral pneumothorax. A 58-year-old woman was treated with acupuncture on the back, neck and chest for poor general condition, and later complained chest discomfort and respiratory difficulty. She was transferred to our center. Her consciousness was clear, blood pressure was 200/110mmHg, pulse rate was 151/minute, respiration rate was 36/minute, and she presented with a cold sweat with no cyanosis, as well as respiratory sounds in both sides of her chest. Cardioechography and electrocardiogram showed no abnormality, and blood examination showed few abnormalities except leukocytosis. Arterial blood gas analysis showed pH 7.215, PaO2 118.7mmHg, and PCO2 63.9mmHg. We made a diagnosis of bilateral pneumothorax upon chest x-ray examination with information from her previous clinic, and performed bilateral thoracic drainage. Arterial blood gas then improved to pH 7.326, PaO2 181.6mmHg, and PCO2 42.8mmHg. She became asymptomatic, recovered, and was discharged on the 13th hospital day. Commonly a patient, who has complications such as pneumothorax after acupuncture therapy, is managed by doctors other than acupuncture therapists. The management of complications after acupuncture therapy is thought insufficient, and under-developed. It is necessary to qualify informed consent, and to better establish cooperation between acupuncture therapists and doctors who managing such complications.
Acupuncture ; Right and left ; Thorax ; Complications Specific to Antepartum or Postpartum ; Pneumothorax

A 43-year old lady presented with progressive loss of vision in both eyes followed by rapid deterioration of consciousness within the next few days. This was preceded by a viral infection one week before her presentation. At presentation she had evidence of meningism and signs of bilateral upper motor neuron lesions and was managed initially as acute meningoencephalitis with antibiotics. The brain CT was within normal limits but subsequent MRI of the brain revealed multiple foci of hyperintense lesions on T2-weighted and FLAIR images. The cerebrospinal fluid examination revealed lymphocytosis, and normal protein and glucose levels. Cultures of the CSF were negative. She was managed as acute disseminated encephalomyelitis (ADEM) with high-dose of intravenous methlyprednisolone one gram/day for three consecutive days followed by oral prednisolone 60 mg/day. Despite the management she lapsed into coma and succumbed to her illness nine days after admission.
Right and left ; seconds ; Lesion, NOS ; Acute ; Optic Neuritis

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of inherited cardio-myopathy, which is characterized by fibro-fatty replacement of right ventricular myocardium, leading to ventricular arrhythmia. However, rapid atrial arrhythmias are also common, including atrial fibrillation, atrial flutter and atrial tachycardia. Long term rapid atrial arrhythmia can lead to further deterioration of cardiac function. This case is a 51-year-old male. He was admitted to Department of Cardiology, Peking University Third Hospital with palpitation and fatigue after exercise. Electrocardiogram showed incessant atrial tachycardia. Echocardiography revealed dilation of all his four chambers, especially the right ventricle, with the left ventricular ejection fraction of 40% and the right ventricular hypokinesis. Cardiac magnetic resonance imaging found that the right ventricle was significantly enlarged, and the right ventricular aneurysm had formed; the right ventricular ejection fraction was as low as 8%, and the left ventricular ejection fraction was 35%. The patients met the diagnostic criteria of ARVC, and both left and right ventricles were involved. His physical activities were restricted, and metoprolol, digoxin, spironolactone and ramipril were given. Rivaroxaban was also given because atrial tachycardia could cause left atrial thrombosis and embolism. His atrial tachycardia converted spontaneously to normal sinus rhythm after these treatments. Since the patient had severe right ventricular dysfunction, frequent premature ventricular beats and non-sustained ventricular tachycardia on Holter monitoring, indicating a high risk of sudden death, implantable cardioverter defibrillator (ICD) was implanted. After discharge from hospital, physical activity restriction and the above medicines were continued. As rapid atrial arrhythmia could lead to inappropriate ICD shocks, amiodarone was added to prevent the recurrence of atrial tachycardia, and also control ventricular arrhythmia. After 6 months, echocardiography was repeated and showed that the left ventricle diameter was reduced significantly, and the left ventricular ejection fraction increased to 60%, while the size of right ventricle and right atrium decreased slightly. According to the clinical manifestations and outcomes, he was diagnosed with ARVC associated with arrhythmia induced cardiomyopathy. According to the results of his cardiac magnetic resonance imaging, the patient had left ventricular involvement caused by ARVC, and the persistent atrial tachycardia led to left ventricular systolic dysfunction.
Arrhythmogenic Right Ventricular Dysplasia/complications* ; Atrial Fibrillation ; Humans ; Male ; Middle Aged ; Stroke Volume ; Ventricular Function, Left ; Ventricular Function, Right