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A 4-day-old girl with Posterior fossa anomalies, Haemangiomas of the head and neck, Arterial, Cardiovascular, and Eye anomalies and ventral developmental defect syndrome comprising a facial haemangioma, aortic coarctation at the aortic arch, torturous aortic aneurysm distal to coarctation, and ductus arteriosus originating proximal to the coarctation is presented. The aortic arch was successfully reconstructed without cardiopulmonary bypass, and she is currently doing well after 4 years and 8 months.
Two species of dirivultid copepod (Siphonostomatoida), Stygiopontius senckenbergi Ivanenko & Ferrari, 2013 and Dirivultus kaiko sp. nov., were discovered from hydrothermal vent fields in the Okinawa Trough, the western North Pacific. Since S. senckenbergi was originally described based on two adult males from the New Ireland Fore-Arc system, Papua New Guinea, the discovery here represents the second record. This species was attached on ventral setae covered with filamentous bacteria of the deep-sea squat lobster Shinkaia crosnieri (Decapoda: Munidopsidae). The female of S. senckenbergi is described for the first time as well as the nauplius I and the copepodid IV. Sexual dimorphism is shown on several appendages (i.e. antennule, leg 2 and leg 5). The nauplius I shows typical lethithotrophic characteristics. Dirivultus kaiko sp. nov., which was found on the tentacular crown of the siboglinid tubeworm Lamellibrachia columna, differs from its two congeners by the antennule, maxilliped and leg 5 of both sexes. These are the second and third dirivultid species to be reported from Japan.
Although thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.
From a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.
A 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Her tumor had been growing rapidly before the referral. Although she did not develop delirium, cerebellar signs, or eye symptoms, we suspected she might have developed TD because of her 2-month loss of appetite as the storage capacity of thiamine in the body is approximately 18 days. The diagnosis of TD was supported by abnormally low serum thiamine levels.
Significance of results
Cancer therapists need to be aware that thiamine deficiency may occur even before the start of cancer treatment. In cases with a loss of appetite of more than 2 weeks’ duration, in particular, thiamine deficiency should be considered if the tumor is rapidly increasing, regardless of the presence or absence of delirium.
Few reports of Wernicke encephalopathy in oncological settings have been published. Some cases of Wernicke encephalopathy are related to appetite loss; however, the degree to which loss of appetite leads to thiamine deficiency is not known.
A 63-year-old female with advanced cancer of the external genitalia was referred for psychiatric consultation because of disorientation, insomnia, and bizarre behaviors. Her symptoms fulfilled the diagnostic criteria for delirium. Routine laboratory examinations did not reveal the cause of the delirium. Thiamine deficiency was suspected because appetite loss had continued for 19 days since she had been admitted to hospital.
Intravenous administration of thiamine resulted in recovery from the delirium within three days. Serum thiamine level was found to be 16 ng/ml (normal range: 24–66 ng/ml). The clinical findings, the low level of thiamine in the serum, and the effective alleviation of delirious symptoms after thiamine administration fulfilled Francis's criteria for delirium induced by thiamine deficiency.
Significance of results:
Clinicians must be aware of the possibility of Wernicke encephalopathy in cancer patients, especially in those with loss of appetite for longer than 18 days. The degree of appetite loss in such patients might serve as a reference. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.
A Japanese girl first pointed out the mass in the left atrial appendage by the echocardiography on the 3rd day of life. At 30th day of life, the mass in the left atrial appendage was excised en bloc successfully under cardiopulmonary bypass because it appeared mobile. Its pathologic finding revealed an old organised thrombus. She is doing well with no episode of thrombus formation or thromboembolism, 2 years postoperatively.
We performed ten operations in children using a lower mid-line incision and limited minimal sternotomy. The skin incision is made from the level of nipples to the lower end of the xiphoid process, and only the body of the sternum is cut vertically. There was neither operative mortality nor complications. The upper limit of the scar was, at the most, 1 cm beyond the level of the nipples, and was difficult to observe in typical open-necked shirts. We believe our method is suitable in fulfilling the cosmetic needs for eligible children.
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