Spontaneous communication between a simple renal cyst and the pyelocaliceal system with a gas-producing infection

We present the extremely rare case of a 44-year-old woman who presented with right flank pain and high fever, which proved to be a case of spontaneous communication between a renal cyst and the pyelocaliceal system caused by increased pressure in the renal pelvic cavity exerted by a stone leading to infection.     

Predominant role of FcgammaRIII in the induction of accelerated nephrotoxic glomerulonephritis

BACKGROUND: Nephrotoxic glomerulonephritis is induced by the administration of antibody against the glomerular basement membrane (GBM). We demonstrated previously that Fc receptors for immunoglobulin G (IgG) (FcgammaR) play crucial roles in the induction of accelerated nephrotoxic glomerulonephritis by using FcRgamma-deficient (-/-) mice. Since FcRgamma-/- mice lack the cell surface expression of two activating FcgammaRs, FcgammaRI and FcgammaRIII. The present study aims to identify the FcgammaR responsible for the induction of nephrotoxic glomerulonephritis. METHODS: Accelerated anti-GBM glomerulonephritis was induced in FcgammaRI-/-, FcgammaRIII-/-, and FcRgamma-/- mice by preimmunization with rabbit IgG followed by inoculation of rabbit anti-GBM antibody. Histologic analysis and immunostaining of renal sections were performed. RESULTS: FcgammaRI-/- mice as well as wild-type mice showed severe glomerulonephritis with hypernitremia by the administration of anti-GBM antibody. In contrast, FcgammaRIII-/- mice showed much milder renal involvement, similar to FcRgamma-/- mice. Histologically, FcgammaRI-/- mice showed intracapillary proliferation, glomerular thrombosis, and crescent formation, whereas FcgammaRIII-/- mice showed only glomerular hypercellular changes. The depositions of anti-GBM antibodies, autologous antibodies and complement C3 along the GBM were equally observed among all three FcR-/- mouse types by immunostaining. CONCLUSIONS: Accelerated nephrotoxic glomerulonephritis is induced predominantly through FcgammaRIII but not FcgammaRI.     

Preoperative evaluation of neural tracts by use of three-dimensional anisotropy contrast imaging in a patient with brainstem cavernous angioma: technical case report

OBJECTIVE AND IMPORTANCE: We describe a case of brainstem cavernous angioma in which the neural tracts were evaluated before surgery by three-dimensional anisotropy contrast (3-DAC) magnetic resonance imaging. CLINICAL PRESENTATION: A 64-year-old man presented with a cavernous angioma located intrinsically in the brainstem and manifesting as gait ataxia. 3-DAC imaging demonstrated that the lesion was located outside the left inferior cerebellar peduncle and inside the middle cerebellar peduncle. INTERVENTION: The intact brain surface was incised, and the lesion was removed successfully on the basis of the preoperative 3-DAC images. The patient exhibited temporary exacerbation of his gait ataxia, but the symptom improved 3 months after surgery. Postoperative 3-DAC imaging demonstrated resection of the lesion and preservation of the left inferior and middle cerebellar peduncles. CONCLUSION: 3-DAC imaging may provide essential information about the neural tracts for the planning of brainstem surgery.     

Correction of auricular deformity caused by high ear-piercing: case report

In recent years, high ear-piercing and wearing earrings in the cartilaginous region of the auricle have become popular. The frequent occurrence of subsequent complications also has been pointed out. The present case is of a 17-year-old girl with an auricular deformity caused by infections occurring after piercing in the scapha. The authors performed an auriculoplasty by excision of the deformed cartilage and autologous cartilage graft from the ipsilateral concha. At present, 1 year and 5 months after the operation, no sign of recontracture is noted, and the auricle remains in a gratifying shape.     

Hydroxyapatite ceramics as a particulate embolic material: report of the clinical experience

BACKGROUND AND PURPOSE: Our newly developed biocompatible embolic materials, hydroxyapatite ceramic microparticles, have good visibility during injection control and were shown to be capable of producing effective occlusion of the distal arteriocapillary bed in an experimental animal study. The purpose of this present study was to evaluate hydroxyapatite ceramic microparticles for use in human meningioma embolization. METHODS: Thirteen patients with meningiomas underwent preoperative superselective embolization with the use of hydroxyapatite microparticles. Radiologic and histopathologic studies of the surgical specimens were performed. RESULTS: During embolization, no microcatheter clogging was observed and angiographic devascularization was consistently obtained without unexpected proximal occlusions. Histopathologic findings showed that there was mild inflammatory response in the thrombosed lumen. CONCLUSION: Hydroxyapatite microparticles are excellent embolic materials for the treatment of human meningioma. They have excellent biocompatibility and good injection control, which produces occlusion of the distal arteriocapillary bed.     

A case of the development of cavum vergae after head trauma

We report a case of the development of cavum septi pellucidi and cavum Vergae after head trauma in a 29-year-old female patient. After the accident, cavum septi pellucidi and cavum Vergae gradually expanded. Using magnetic resonance imaging, we followed up the patient for 33 months after the head trauma. Preoperatively, metrizamide CT cisternography was performed in order to investigate CSF flow between the cavum septi pellucidi/cavum Vergae and the subarachnoid space. Using neuroendoscopy, we succeeded in opening the wall of the cavum septi pellucidi via anterior horn of the right lateral ventricle. Cystography was performed during the operation. The volume of the cavum septi pellucidi/cavum Vergae decreased remarkably. In this case, our CSF flow studies revealed that CSF flowed into the posterior part of the cavum Vergae from the third ventricle and did not flow backward to the third ventricle. Therefore, we considered that the development of cavum septi pellucidi/cavum Vergae was related to a one-way valve mechanism between the posterior part of the cavum Vergae and the third ventricle.     

Safety management in operating rooms

In operating rooms, patients with a wide range of conditions are transferred from the wards to undergo surgery. Furthermore, because surgeons with different specialties perform various operations using instruments unique to their specialty, it is possible that operating room nurses, surgeons, and ward nurses do not always communicate clearly. Patients are anesthetized and unconscious, and as a general rule, family members are not allowed entry. As a result, operating rooms are unique environments where neither the patients receiving medical services nor their families can express opinions and concerns. Therefore an especially strict crisis management approach is needed in operating rooms. At present, individual hospital implement their own crisis management systems to prevent medical accidents. However, national debate is needed to establish medical accident prevention guidelines before each hospital compiles a manual that suits its needs.     

Plastic Iodophor Drape during Liver SurgeryOperative Use of the Iodophor-impregnated Adhesive Drape to Prevent Wound Infection during High Risk Surgery

We retrospectively investigated factors associated with wound infection after liver resection for hepatocellular carcinoma (HCC), with special reference to use of a plastic adhesive drape impregnated with iodophor. The subjects were 296 patients undergoing liver resection for HCC. Wound infection was defined as purulent drainage from the superficial incision with or without laboratory confirmation. One or more of the following signs was required: pain or tenderness, localized swelling, or redness or heat. Wound infection developed in 25 patients. Regression analysis indicated that low body mass index (BMI), smoking, long preoperative hospital stay, and nonuse of iodophor drapes were risk factors for wound infection. Wound infection was significantly less likely with the use of iodophor drapes (3.1%) than for surgery without iodophor drapes (12.1%). By multivariate regression analysis, BMI, smoking, and lack of drape use were independent risk factors. Most of the bacteria isolated were skin bacteria, including Staphylococcus aureus and Staphylococcus epidermidis. In conclusion, low BMI, smoking, a long preoperative hospital stay, and the lack of iodophor drape use were risk factors for wound infection after liver resection for HCC. The drapes presumably prevented contamination from the skin during the operation.     

A case of membranous nephropathy with ANCA-associated necrotizing glomerulonephritis during oral administration of PTU for Graves' disease

We experienced a coincidental case of two types of glomerulopathy associated with Graves' disease. A 64-year-old man, who had been treated with propylthiouracil(PTU) for Graves' disease for 15 years, was admitted to our hospital for macroscopic hematuria and rapidly progressive deterioration of renal function. Although his thyroid function had been within the normal range during treatment, the level of thyrotropin receptor antibody(TRAb) gradually increased from a year before admission. Serological tests revealed that he was positive for myeloperoxidase-antineutrophil cytoplasmic antibody(MPO-ANCA). The renal biopsy specimen showed necrotizing and crescentic glomerulonephritis(GN) superimposed on membranous nephropathy(MN). This is a rare case of MN complicated with ANCA associated crescentic GN in a Graves' disease patient. Association of these two renal alterations was not clearly defined. MN involved with Graves' disease also has been rarely reported. Some reports demonstrated deposition of thyroglobulin and other thyroid related antigens in the glomeruli. In the present case, long-term impairment of Graves' disease and elevation of TRAb might have been responsible for the formation and deposition of thyroid-associated immune complex in the glomeruli. As for crescentic GN, PTU might have induced ANCA-associated GN independently of MN. This case is instructive for considering the relation between Graves' disease and renal injury.