Familial occurrence of congenital bile duct cysts

Congenital bile duct cysts are now a well-documented anomaly of the biliary tree, and have become more common in Japan. Familial occurrence of congenital bile duct cysts, however, is extremely rare, with only six reported cases in the literature. We report a familial pattern of congenital bile duct cysts in a mother and her daughter. A 33-year-old female was admitted for evaluation of right upper quadrant abdominal pain and fever 6 days after an uneventful delivery of her second child. A com- puted tomography (CT) and ultrasound scan (US) revealed an obstructed biliary tract. Percutaneous transhepatic biliary drainage was then performed, and a cholangiogram revealed a Scholtz type B choledochocele without an anomalous connection of the pancreaticobiliary ducts. Endoscopic US demonstrated that the choledochocele was associated with a stone in the cyst. A pylorus-preserving pancreatoduodenal resection was performed, and a histological study revealed that the choledochocele was lined by biliary mucosa without evidence of malignancy. The newborn infant had an abdominal tumour. An US and CT revealed a congenital bile duct cyst. An operation was performed and the intraoperative cholangiogram showed an Alonso-Lej type I congenital bile duct cyst with an anomalous connection of the pancreaticobiliary ducts. Whether congenital bile duct cysts are hereditary remains to be elucidated.     

p75NGFR Immunostaining for the Detection of Perineural Invasion by Cutaneous Squamous Cell Carcinoma

BACKGROUND: Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) may portend a poor prognosis for patients. p75NGFR (nerve growth factor receptor) is part of a membrane receptor complex that binds nerve growth factor. Its use for detecting PNI in CSCC in comparison with S-100 immunohistochemical staining has not been explored. OBJECTIVE : To determine whether detection of PNI may be improved by staining with p75NGFR compared with hematoxylin and eosin (H&E) and S-100. METHODS: Thirty-four cases of CSCC were retrospectively evaluated for the presence of PNI using standard H&E, as well as S-100 and p75NGFR immunohistochemical stains. Staining intensity was correlated to the presence or absence of PNI and tumor differentiation. RESULTS: The results showed a positive correlation between staining intensity and the presence of PNI detected by p75NGFR (p=.04). Using p75NGFR allowed for the detection of seven cases of PNI not detected by H&E alone. Five of these cases were detected by S-100, with two cases seen by p75NGFR only. Six cases of PNI were detected using S-100 not seen on H&E, with one case also not seen using p75NGFR. CONCLUSION: p75NGFR immunostaining increased detection of PNI compared with H&E. p75NGFR could serve as an alternative to S-100 in the detection of PNI or as part of an immunostaining panel for PNI detection.     

Mucoid pseudocyst of the obturator nerve

A 71-year-old man visited the outpatients' clinic of National Saitama Hospital, Japan, complaining of pain in the right leg. Magnetic resonance imaging (MRI) revealed a cystic mass adjacent to the right side of the urinary bladder. He underwent the removal of the cystic mass and the pathological diagnosis was a mucoid pseudocyst of the obturator nerve. After tumor resection, the pain was diminished and he has been free of disease for 3 years.     

Laparoscopic Follow-up of Asymptomatic Primary Biliary Cirrhosis with Negative Anti-mitochondrial Antibody

Abstract: The case of a 59 year-old female with asymptomatic primary biliary cirrhosis with negative anti-mitochondrial antibody is presented. According to the results of the first laparoscopy and liver biopsy, reddish patch was observed but chronic non-suppurative destructive cholangitis could not histologically be confirmed. A follow-up laparoscopy with liver biopsy conducted 39 months after the first laparoscopy revealed progress in the laparoscopic findings, i. e. a focal appearance of mesh-like white marking and undulation, when chronic non-suppurative destructive cholangitis was histologically demonstrated. Following the diagnosis of primary biliary cirrhosis, ursodeoxycholic acid treatment was begun, and the patient's serum levels of transaminases and biliary tract enzymes showed a rapid improvement. The importance of a laparoscopy with liver biopsy for the diagnosis of asymptomatic primary biliary cirrhosis in a case with negative anti-mitochondrial antibody is emphasized, and the follow-up of such a case discussed.     

Thrombolytic therapy for traumatic unilateral renal artery thrombosis

We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17-year-old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360,000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.     

Application of a Circular Polarizing Device to an Electronic Endoscope for the Purpose of Prevention of Catch-Light Phenomenon

Abstract: In recent years the electronic endoscope has been increasingly used by medical practitioners in Japan. However, it has been noted that the problem of too strong light refection, which, not only hampers the procedure but also causes eye exhaustion, at the same time making photographic or computerized image processing difficult, is more frequently experienced and is more serious in magnitude when compared with using a conventional fiberoptic endoscope (catch-light phenomenon). In order to ameliorate this problem the authors experimented with the use of circularly polarized light. The combined use of a circular polarizing device to the efferent light path and a filter which blocks certain types of Circularly polarized light to the afferent path has proved to be very effective in eliminating the incidence of catch-light troubles, thus making the endoscopic procedure smooth and efficient.     

Abnormalities of Immunologic Response of Lymphocytes in Patients With Cancer of the Digestive Organs

The lymphocyte functions of 174 patients with cancer of thedigestive organs were studied, with particular reference tothe percentage of T cells bearing receptors for the Fc portionof IgG (T_G cells), phytohemagglutinin (PHA) response of thelymphocytes and the helper activity of T cells. The percentageof T_G cells was 12.18±6.91% (mean±SD) before treatment,exceeding the upper limit of the normal value (8%) in 49.4%of the patients. However, it decreased significantly to 7.98±6.3%after surgical removal of the tumors (r=0.746, P<0.001).The possible correlations of this parameter with two otherswere investigated in order to find a more reasonable parameterfor tumor immunology. An increased percentage of T_G cells anda decreased PHA response of the lymphocytes were found in 5.8%of the cases of stage I, 42.8% of the cases of stage II, 33.3%of the cases of stage III and 48.9% of the cases of stage IVcancer. An increased percentage of T_G cells and a decreasedhelper activity of T cells were found in 20% of the cases ofstage I, 20% of the cases of stage II, 25% of the cases of stageIII and 33.3% of the cases of stage IV. When only gastric cancerpatients were considered, a decreased PHA response of the lymphocytesand an increased percentage of T_G cells were found in 12.5%of the patients with early stages. while this profile was observedin 25.5% of the patients with advanced stages of the disease.An increased percentage of T_G cells and a decreased helper activityof T cells were found in 18.7% of the patients with early stagesand 37.9% of the patients with advanced stages. These findingssuggest that if the three immunological parameters were usedin the above combinations, they might more accurately reflectchanges in immunity with the progress of cancer.