Richter's syndrome is generally accepted taht lymphoma or leukemia of low grade malignancy, during their course, may alter both their morphologic and clinical appearance and evolve into highly malignant neoplasia. The pathogenesis is not clear, however, dedifferentiation by the emergence of a new clone of cells of higher maligancy similar to the blastic transformation in chronic myelocytic leukemia is suggested as possible mechanism. A case of Richter's syndrome is described. This 45 year old female had been diagnosed as chronic lymphocytic leukemia by absolute peripheral lymphocytosis 5 months before, developed sudden severe abdominal pain and was received segmental resection of ileum under the clinical impression of intestinal perforation with peritonitis. Histologically, the ulcer margin was diffusely infiltrated by polymorphic cells composed of large atypical cells having vesicular nuclei, multinucleated giant cells and Reed-Sternberg like cells admixed with mature lymphocytes. These atypical and multinucleated cells of the paraffin section showed strong monoclonal immunoreactivity for IgG and lambda light chain by PAP method and was interpreted as malignant lymphoma, diffuse, large cell, immunoblastic, polymorphous.
Female ; Humans

Changes in retinal sensitivity within central 30 degrees following panretinal photocoagulation (PRP) for more severe diabetic retinopathy were investigated. Twenty-five eyes with visual acuity of 0.4 or better and minimal maculopathy were studied prospectively. All underwent PRP in two sittings, and Humphrey field analyzer 30-2 threshold test was done before and 1 week, 1 and 3 months after the treatment. The mean retinal sensitivity threshold was obtained from each hemifield between 15 and 30 degrees and from the central 15 degree area, and the changes in the values were analyzed. Mean sensitivity threshold in the upper visual field at pre-PRP, post-PRP 1 week, 1, 3 months were 15.62, 13.81, 14.31, 14.85, respectively. Values in the lower field were 18.71, 17.25, 17.10, 18.17. Difference between pre-PRP and post-PRP was statistically significant at 1 week but no longer thereafter. Retinal sensitivity within the central 15 degrees remained stable. The data show that retinal sensitivity decreases significantly 1 week after PRP but recovers upto 95% of pre-PRP level over the following 3 months.
Adult ; Aged ; Diabetic Retinopathy/*physiopathology/surgery ; Female ; Follow-Up Studies ; Humans ; *Laser Coagulation ; Male ; Middle Aged ; Prospective Studies ; Retina/*physiopathology ; Sensory Thresholds ; Visual Acuity/physiology ; Visual Fields/*physiology

In order to prevent the development of central island after excimer laser photorefractive keratectomy(PRK), 547 eyes which had undergone PRK were studied to evaluate the incidence, width and height of central island retrospectively. Based on this result, PRK was performed on 63 eyes under conventional protocol(software version 3.20, VISX Twenty/twenty Inc, Santa Clara, CA) and then additional laser ablation with a correction amount of 2.5D and adiameter of 3mm was performed whether the incidence has been decreased and additional complications have occurred. As a result of conventional protocol, central island had occurred in 121 eyes out of 547(22.1%) and the width was 2.94+/-0.22mm and the height was 2.64+/-0.89D. In case of 63 eyes which underwent additional laser ablation, central island occurred in 4 eyes (6.34%) and overcorrection occurred only in 3 eyes(4.76%) at one month after PRK. From the standpoint of the above results, we reached the conclusion that the additional ablation for 2.5D by a 3mm in diameter after PRK under conventional protocol is effective. By using this method, we could reduce the incidence of central island without the aid of the upgraded version that contains the anti-central island program.
Incidence ; Laser Therapy ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy* ; Retrospective Studies

Background and Objectives: Auditory training involves active listening to auditory stimuli, and it has garnered attention in recent years because it enhances speech-in-noise recognition and the satisfaction of hearing aids. The purpose of this study was to determine the efficacy of a closed-set auditory training protocol for adult hearing aid users. We also evaluated the retention effect of training at a 1-month follow-up test after the completion of training. Subjects and Methods: Twenty-two hearing-impaired listeners who have used bilateral hearing aids for more than two months participated in this study. Out of 22 participants, 12 participants (training group, TG) received an 8-week auditory training while 10 participants did not receive any training (non-training group, NTG). For training, three types of closed-set training materials (environmental sounds, words, and sentences) were used. The training was conducted eight times over eight weeks (one session per week, about one hour per session). The difficulty level was adjusted by controlling the number of closed-set choices and the signal-to-noise ratios. To determine the efficacy of training, open-set speech recognition abilities and subjective hearing aid satisfaction were evaluated. Results: All the open-set speech recognition performances of the TG were enhanced after the closed-set auditory training, while the performance of the NTG was not significantly changed. The auditory training had a positive impact on the TG individuals’ subjective satisfaction of hearing aids. The improvement from training was maintained over one month after the completion of the auditory training. Conclusion The closed-set auditory training protocol might lead to enhanced speech understanding as well as more satisfaction with hearing aids for adult hearing aid users.

OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for beta-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. CONCLUSIONS: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.
Adrenergic beta-Antagonists/therapeutic use ; Age Factors ; Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases/complications/drug therapy/*epidemiology ; Diabetes Complications ; Diabetes Mellitus/diagnosis ; Female ; Humans ; Hypercholesterolemia/complications/diagnosis ; Hypertension/complications/diagnosis ; Male ; Middle Aged ; Percutaneous Coronary Intervention/*statistics & numerical data/trends ; Prevalence ; Registries/statistics & numerical data ; Risk Factors ; Smoking ; Time Factors

Ever since transplant surgery became a common procedure. The early diagnosis of irreversible cessation of cerebral function has become an important need We analysed the findings of transcranial doppler of five cases. Two was diagnosed brain death by currently accepted criteria. Two cases showed absence of intracranial blood flow and normal to disturbed flow status of the cervical carotid artery. Three cases showed reverberating flow pattern with reflux phenomenon. Transcranial doppler investigation seems to provide a practical, non-invasive. And reliable disgnostic evidence for the arrest of cerebral circulation.
Brain Death* ; Brain* ; Carotid Arteries ; Diagnosis* ; Early Diagnosis

GTPrS-dependent phospholipase D activity in human neutrophils was investigated using exogenous phospholipid as a substrate. Both cytosolic and membrane- associated phospholipase D activities were identified. The previously described 50 kDa cytosolic activating factor was resolved chromatographically from the cytosolic phospholipase D. Using exogenous phospholipid as substrate along with chromatographically resolved 50 kDa factor and recombinant ADP-ribosylation factor 1, plasma membrane was required for activity, indicating that the activity which was previously seen using endogenous phospholipid substrate was due to a phospholipase D located in the plasma membrane. In addition, ADP-ribosylation factor and the 50 kDa factor activated synergistically. Using neutrophil plasma membranes, a third regulator of neutrophil membrane phospholipase D was identified from bovine brain cytosol. This factor was resolved from ADP-ribosylation factor and Rho A by successive column chromatographies. The brain factor showed a synergistic effect with the 50 kDa neutrophil activator but an additive effect with recombinant ADP- ribosylation factor. Whether or not ADP-ribosylation factor or the brain factor were present, high activities were seen only when the 50 kDa factor was present, indicating that the 50 kDa cytosolic factor is a major activating factor for the neutrophil plasma membrane phospholipase D.
ADP-Ribosylation Factor 1 ; ADP-Ribosylation Factors* ; Brain* ; Cell Membrane ; Chromatography ; Cytosol* ; Fibrinogen ; Humans ; Membranes ; Neutrophils* ; Phospholipase D* ; Phospholipases*

PURPOSE: The mechanisms, which alter urinary bladder muscle function during infectious cystitis, are poorly understood. The objective of this study was to identify potential resident targets for endotoxin lipopolysaccharide(LPS) within normal bladder smooth muscle and test the hypothesis that LPS induces an inflammatory response within the bladder muscle and that this is associated with a decrease in muscle contractility. MATERIALS AND METHODS: Male rats were studied 24 hours after a single bolus i.p. injection of LPS(15mg/kg). Whole-mount preparations of the bladder muscle were immunohistochemically stained for neutrophils(myeloperoxidase), macrophages(ED2), activated leukocytes(LFA-1) and mast cells(FITC-Avidin). Contractile activity was assessed from muscle strips of the bladder in response to bethanechol(0.3-300microM). Voiding frequency and urine volume for 24 hours were measured using metabolic cage. Cystometry was performed to measure the intravesical bladder pressure. RESULTS: Using the resident macrophage marker ED2, dense network of macrophages were observed within the bladder muscle of control and LPS treated rats. Few neutrophils(myeloperoxidase-positive cells, 2.3 +/- 0.38 cells, x200) were detected in whole-mounts of bladder muscle of control rats, while LPS pretreatment resulted in a significant increase in the number of neutrophils which demonstrate inflammatory response(10.8 +/- 1.70 cells, x200, p<0.001). LFA-1 immunohistochemistry demonstrated an increased presence of LFA-1 positive cells in bladder muscle of LPS treated rats, which had a morphology similar to both neutrophils and resident macrophages. The expression of LFA-1 is known as a marker of cells that are in an activated state. LPS pretreatment resulted in a significant reduction in bladder muscle contractions in response to bethanechol(i.e. control = 0.049 +/- 0.010 vs. LPS= 0.029 +/- 0.003 gr/mm2/sec, 100microM, p<0.05). Voiding frequency of LPS treated rats was significantly increased compared to that of control rats. In LPS treated rats, voiding phase representing bladder contractility in cystometry was observed. CONCLUSIONS: These data demonstrate that a single intraperitoneal injection of LPS initiates an inflammatory response within the bladder muscle that is associated with a decrease in the functional activity of the bladder. We hypothesize that secretions from the resident macrophages and extravasated leukocytes within the muscle cause the observed suppression in bladder muscle activity in vitro.
Animals ; Cystitis ; Humans ; Immunohistochemistry ; Inflammation* ; Injections, Intraperitoneal ; Leukocytes ; Lymphocyte Function-Associated Antigen-1 ; Macrophages ; Male ; Muscle Contraction ; Muscle, Smooth ; Neutrophils ; Rats* ; Urinary Bladder*

PURPOSE: To evaluate the results of anterolateral thigh perforator free flap for reconstruction of foot and ankle in old diabetic patients. MATERIALS AND METHODS: Fifteen diabetic foot ulcer patients over the age of 55 were operated with anterolateral thigh perforator free flap. Hematological, hemodynamic, diabetic, bacteriologic and radiologic tests were checked with examination of blood vessel state in both the donor site and the recipient site. After surgery, serial check-up was performed at 6 week, 6 month, and 1 year postoperatively on the survival of transplantation tissue, condition of foot, and condition of walking. RESULTS: There are one case of transplantation failure and four cases of partial tissue-necrosis. Delayed wound-healing was observed both recipient and donor tissue sites. At the final follow up, three cases of small ulcer were found at junction of flap and recipient tissue in plantar area. Fourteen out of fifteen patients could walk without any brace or walking aids. CONCLUSION: Reconstruction of foot and ankle region in old diabetic patients with the anterolateral thigh perforator free flap is a useful method which can prevent the amputation of foot and ankle
Aged ; Amputation ; Animals ; Ankle ; Blood Vessels ; Braces ; Diabetic Foot ; Follow-Up Studies ; Foot ; Free Tissue Flaps ; Glycosaminoglycans ; Hemodynamics ; Humans ; Thigh ; Tissue Donors ; Transplants ; Ulcer ; Walking

Enflurane* ; Metabolism* ; Methoxyflurane* ; Panax*