Spontaneous subcapsular hepatic hemorrhage associated with pregnancy: Report of a case

We report herein a case of spontaneous subcapsular hepatic hemorrhage which occurred in a 33-year-old woman 1 day after she had been delivered of her second child by cesarean section following an uneventful pregnancy. She complained of right upper quadrant pain on the 1st postoperative day, and computed tomography (CT) showed subcapsular low-density masses in both liver lobes, while extravasation was demonstrated by CO₂ intraarterial digital subtraction angiography (IADSA). The hemorrhage was successfully controlled by transcatheter arterial embolization (TAE). However, on the 3rd day after TAE, an exploratory laparotomy was performed to establish an exact diagnosis to explain the persistent abdominal pain and abnormal liver function tests. Subcapsular hematomas in both lobes were confirmed and no visible laceration was present. The patient recovered gradually by spontaneous absorption of the hematomas and was discharged on the 22nd postoperative day. Spontaneous hepatic hemorrhage associated with pregnancy is a very rare complication, and establishing a correct diagnosis and initiating appropriate therapy are essential for this life-threatening disease.     

Glucose tolerance in Papua New Guinea: ethnic differences, association with environmental and behavioural factors and the possible emergence of glucose intolerance in a highland community

That Melanesians of non-Austronesian genetic ancestry may be relatively resistant to glucose intolerance was supported by the results of a study of two semitraditional non-Austronesian villages in the Papua New Guinean highlands in 1983, in which an absence of diabetes and a high degree of glucose tolerance and insulin sensitivity were observed. The second of this series of surveys was conducted in 1985 in three non-traditional communities: a periurban, non-Austronesian village in the highlands, and rural and periurban Austronesian villages in coastal locations. Although an absence of diabetes was demonstrated once again in the highlanders, these periurban subjects showed an unexpectedly high insulin response which may be a precursor of glucose intolerance. The notion that highland communities that are living in non-traditional circumstances in Papua New Guinea presently are in "metabolic transition" towards diabetes and other non-communicable diseases, if correct, is of importance to the public health of the nation. In the periurban, coastal-dwelling Austronesians, diabetes with severe hyperglycaemia was demonstrated, and there was some evidence of a secular trend towards increasing glucose intolerance. The two-hour plasma glucose concentrations were shown to be associated with obesity, modernity and Seventh-Day Adventist religious persuasion. However, important and unexplained differences in glucose tolerance remained between rural and periurban coastal dwellers after taking these factors into account.     

Pharmacological evidence that tetraethylammonium-sensitive,iberiotoxin-insensitive K+ channels function as a negative feedback element for sympathetic neurotransmission by suppressing ω-conotoxin-GVIA-insensitive Ca2+ channels in the relaxation of rabbit facial vein

Naunyn-Schmiedeberg's Archives of Pharmacology -     

Clinical features and treatment outcomes of dedifferentiated and grade 3 chondrosarcoma: A multi‐institutional study

Chondrosarcoma is the second most common primary malignant bone tumor. In this multicenter study, we sought to evaluate the disease‐specific survival (DSS) and disease‐free survival (DFS), and prognostic factors in patients with dedifferentiated chondrosarcoma (DDCS) or grade 3 chondrosarcoma (G3CS) in Japan. We retrospectively investigated the treatment outcomes and prognostic factors in 62 patients with DDCS and 19 patients with G3CS at 15 institutions participating in the Japanese Musculoskeletal Oncology Group. We also clarified significant clinicopathological factors for oncological outcomes. In surgery for primary lesions aimed at cure, a histologically negative margin (R0) was obtained in 93% (14/15) of patients with G3CS and 100% (49/49) of patients with DDCS. The 5‐year DSS was 18.5% in patients with DDCS and 41.7% in patients with G3CS (p = 0.13). Local control was obtained in 80% (12/15) and 79.6% (39/49) of patients with G3CS and DDCS in the primary lesion after surgery with a wide surgical margin, respectively. In multivariate analysis, stage and no treatment/palliative treatment for the primary lesion were independent prognostic factors for DSS of DDCS, and age and no treatment/palliative treatment for DSS of G3CS. The 5‐year DFS rate was 22.8% in 26 patients with DDCS who did not receive adjuvant chemotherapy, and 21.4% in 14 patients who received adjuvant chemotherapy. The prognosis of DDCS remains poor, although R0 resection was carried out in most cases. Effective and/or intensive chemotherapeutic regimens or agents should be considered or developed for patients with high‐grade chondrosarcoma, particularly for those with DDCS.     

Comparison of multishot echo-planar fluid-attenuated inversion-recovery imaging with fast spin-echo fluid-attenuated inversion-recovery and T2-weighted imaging in depiction of white matter lesions

PURPOSE: To compare a multishot echo-planar fluid-attenuated inversion-recovery (EPI-FLAIR) sequence with fast spin-echo FLAIR (F-FLAIR) and fast spin-echo T2-weighted (FSE-T2W) sequences in depiction of white matter lesions. METHODS: Thirty-five patients with various white matter lesions were included in this prospective study. Two independent readers for lesion detection (lesion size, >2 mm) compared sequences quantitatively. In 22 patients, contrast was calculated between periventricular hyperintensity (PVH) and the cerebrospinal fluid (CSF). RESULTS: EPI-FLAIR revealed more lesions than FSE-T2W (p < 0.01). However, F-FLAIR revealed more lesions than EPI-FLAIR (p < 0.01). For PVH-to-CSF contrast, EPI-FLAIR demonstrated significantly higher contrast than FSE-T2W. There were no differences in PVH-to-CSF contrast between EPI-FLAIR and F-FLAIR. CONCLUSIONS: This study shows that EPI-FLAIR has distinct advantages over FSE-T2W in the depiction of white matter lesions. Although EPI-FLAIR reduces imaging time by more than 60% relative to F-FLAIR, it cannot replace F-FLAIR for the detection of lesions in the cerebral white matter.     

Spontaneously stabilized severe dysplastic spondylolisthesis without operation: long-term follow-up of a preteenage patient

Surgical management is the accepted treatment choice for grade III or IV spondylolisthesis, and many satisfactory clinical and radiologic follow-up results have been reported. Very little, however, has been written about long-term results in preteenage patients in whom dysplastic spondylolisthesis has been treated nonoperatively, especially in those who have > or =50% displacement of the fifth lumbar vertebra on the sacrum. We report an unusual case of spontaneous stabilization of severe dysplastic spondylolisthesis in an 8-year-old girl who presented with grade III spondylolisthesis of L5-S1 and was followed up for >14 years in the absence of surgical intervention. On presentation, she complained of a restriction in forward bending and tightness of hamstrings, but she was undisturbed in her daily activities. Initial radiographs showed severe dysplastic spondylolisthesis; however, magnetic resonance imaging (MRI) performed at age 9 years showed that the amount of listhesis was much less than that seen in the initial radiograph. Routine radiographic follow-ups were chosen over early operative measures until she became a teenager. There was no change in the slip, and unusually a gradual ossification of the cartilaginous promontory of the S1 and the posterior lip of the L5 was observed. At 22 years old, the patient is asymptomatic and not conscious of her cosmetic appearance. Surgical treatment has generally been indicated for patients with grade III or IV spondylolisthesis, because slippage progression has been noted in most reported cases. However, MRI may be a tool for predicting which dysplastic spondylolisthesis cases are more likely to progress and therefore circumvent surgical intervention, while maintaining an excellent outcome.     

Solitary metastasis to the intercostal muscle from hepatocellular carcinoma: A case report

INTRODUCTIONSkeletal muscle metastases from carcinomas, especially to intercostal muscles, are rare. Most metastatic chest wall tumors from hepatocellular carcinoma (HCC) result from disseminations through needle tracts of intrahepatic HCC treatments.PRESENTATION OF CASEWe report the case of a 65-year-old man with chronic viral hepatitis B whose intrahepatic lesions were stabilized by repeated radiofrequency ablations and transcatheter arterial chemoembolization. Follow-up computed tomography demonstrated a well-enhanced mass in the right chest wall. Because α-fetoprotein and des-γ-carboxy prothrombin levels were elevated and no other tumors were detected, we diagnosed the mass as an extrahepatic metastasis from the HCC and resected it along with the surrounding ribs. There was no involvement of the bone, pleura, and lung.DISCUSSIONThe tumor was microscopically diagnosed as an intercostal muscle tumor metastasized from HCC, which has not been documented previously. The resection rate of extrahepatic tumors of HCC is low in literature. No other apparent extrahepatic recurrence has been observed for more than 20 months after the surgery.CONCLUSIONWe report the case of HCC patient who underwent surgical resection of an intercostal muscle tumor that had metastasized from HCC. Pathological examination of the tumor revealed the tumor cells in the blood vessels, and we speculate it hematogeneous metastasis.     

Allograft Rejection of Small Bowel Transplantation in Pigs

n = 9): nonimmunosuppressed recipients; (2) group 2 (n = 8): FK506-immunosuppressed recipients; (3) group 3 (n = 2): autotransplant controls; and (4) donors (n = 17). Orthotopic small bowel transplantations were performed with Thiry-Vella loops for daily biopsies. The survival rate of group 2 was significantly longer than that of group 1 (P < 0.05). One best survivor in group 2 was killed at postoperative day (POD) 365. Treatment by FK506 prevented rejection, but most of the pigs died of pneumonia. In group 1, rejection began on POD 3 and progressed to severe rejection rapidly within 7 days. In group 2, rejection began from POD 6 to POD 8, but either remained mild or spontaneously improved. The differences in the routine laboratory data and the tumor necrosis factor-α level were not evident between the groups. Histological studies of repeated graft biopsies are thus considered to be essential for detecting signs of graft rejection. (Received for publication on Mar. 26, 1997; accepted on Jan. 6, 1998)