Intradiploic arachnoid cyst identified by diffusion-weighted magnetic resonance imaging--case report

A 72-year-old woman presented with an intradiploic arachnoid cyst in the occipital intradiploic space which was found incidentally by magnetic resonance (MR) imaging. Computed tomography revealed a widened diploic space and thinning of the inner and outer tables of the occipital bone. The cyst appeared as isointense to the cerebrospinal fluid on both T1- and T2-weighted images. The differential diagnosis of intradiploic epidermoid cyst could be excluded because the lesion was low intensity on diffusion-weighted MR images. Arachnoid cyst is a benign lesion, so exploratory surgery should be avoided unless the cyst is symptomatic. Diffusion-weighted MR imaging is an effective modality to distinguish diploic epidermoid cysts from arachnoid cysts.     

Functional Mediastinal Parathyroid Cyst: Report of a Case

We report herein a rare case of a functional mediastinal parathyroid cyst. A mediastinal tumor was detected by a chest X-ray film and subsequent computed tomography (CT) scan in a 68-year-old woman who was asymptomatic. Biochemical examination revealed that her serum calcium and intact-parathyroid hormone (i-PTH) levels were above the normal range. The findings of chest CT and magnetic resonance imaging suggested a cystic mass. The mass, which adhered tightly to its surrounding structures, was resected through a median sternotomy. The patient had an uneventful postoperative course, and her serum calcium and i-PTH levels rapidly returned to within the normal range. Received: March 21, 2001 / Accepted: September 11, 2001     

Invasive Ductal Carcinoma of the Breast Associated with Poland's Syndrome: Report of a Case

We report herein a rare case of invasive ductal carcinoma of the breast associated with Poland's syndrome. The patient was a 59-year-old woman who was referred to our department after a nodule had been found in the upper outer portion of the left breast by a breast cancer screening program. On physical examination, marked hypoplasia of the right breast and upper limb was noted. Preoperative computed tomography also revealed a defect in the right pectoralis muscles. A quadrantectomy of the left breast with lymphadenectomy was subsequently performed and pathological examination of the resected specimen showed invasive ductal carcinoma. Her medical history revealed that her mother had attempted to abort the pregnancy around the fifth week of her gestation. The present case suggests that such an event during gestational development may be associated with congenital anomalies predisposing to malignant disorders. Received: January 10, 2001 / Accepted: July 17, 2001     

Impaction of a Shrapnel Splinter in the Common Bile Duct After Migrating from the Right Thoracic Cavity: Report of a Case

Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1 mg/dl, an alanine aminotransferase level of 24 IU/l, and an alkaline phosphatase level of 18.5 KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body. Received: March 14, 2001 / Accepted: September 11, 2001     

Effects of Modified Ultrafiltration on Coagulation Factors in Pediatric Cardiac Surgery

Purpose. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children has been reported to reduce the need for postoperative blood transfusion and minimize postoperative blood loss. This study was undertaken to quantify the effects of MUF on coagulation factors in pediatric patients. Methods. Seven children scheduled to undergo open-heart surgery for congenital heart defects were studied. CPB cir-cuits were primed with crystalloid solutions and no blood transfusions were performed. Hematocrit, platelet count, total plasma proteins, albumin, fibrinogen, prothrombin, factor VII, factor IX, and factor X were measured preoperatively, at the termination of cardiopulmonary bypass, and at the end of modified ultrafiltration. Results. MUF was associated with significant (P < 0.05) increases in hematocrit (17.6% ± 1.6% to 21.6% ± 2.4%), platelet count 11.1 ± 2.5 to 12.8 ± 2.4 × 10⁴/mm³), total plasma proteins (2.7 ± 0.3 to 3.4 ± 0.4 g/dl), and albumin (1.6 ± 0.2 to 2.1 ± 0.2 g/dl). Fibrinogen, prothrombin, and factor VII also increased significantly (P < 0.05) during MUF, but factor IX and factor X did not change. Conclusion. We conclude that MUF attenuates the dilutional coagulopathy that occurs during CPB in children. There were slight improvements in the coagulation factors when MUF was employed. Received: October 5, 2000 / Accepted: September 11, 2001     

Mitogen-activated protein kinase inhibitor,PD98059, inhibits rat retinal pigment epithelial cell replication by cell cycle arrest

PURPOSE: To investigate the effect of PD98059, a mitogen-activated protein kinase (MAPK) inhibitor, on the replication of rat cultured retinal pigment epithelial (RPE) cells. METHODS: Growth-phase rat RPE cells were exposed to various concentrations of PD98059 in serum-free F12 medium containing 0.1% dimethyl sulfoxide. Cell proliferation was assessed by cell counts using a hemocytometer. Cell viability was tested by CellTiter 96 AQueous Non-Radioactive Cell Proliferation Assay at 24 hours after PD98059 application. Hoechst 33552 and propidium iodide staining were used to assess nuclear morphology. Immunostaining with Ki67 antibody was used for cell cycle analysis because the staining patterns produced on cells are characteristic depending on their position within the cell cycle. RESULTS: PD98059 inhibited cellular proliferation of cultured rat RPE cells in a dose-dependent manner but did not induce cell death. Twenty-four hours after the application of PD98059, cultured RPE cells were not immunopositive for Ki67, indicating that their cell cycle was arrested in the G0/G1 phase. CONCLUSION: These results demonstrated that MAPK inhibition arrested cell cycle progression of rat cultured RPE cells at the G0/G1 phase. The pharmacological induction of cell cycle arrest could be a new approach to inhibit cellular proliferation in such conditions as proliferative vitreoretinopathy.     

Surgical treatment of limbal vernal keratoconjunctivitis by resection of a limbal lesion

PURPOSE: To report our experience managing a limbal mass associated with limbal vernal keratoconjunctivitis (VKC) by surgical excision. METHODS: A 16-year-old girl was referred to our hospital with the chief complaints of itching and photophobia in both eyes. She had a 2-year history of gradually enlarging limbal gelatinous masses on the temporal limbus in both eyes, which were diagnosed as limbal papillae of VKC. As the symptoms in her left eye were more severe, surgical resection of the limbal mass in her left eye was performed to relieve mechanical stress on the eyelid, followed by a free conjunctival autograft taken from the supranasal bulbar conjunctiva. RESULTS: After excision of the mass, ocular inflammation and other symptoms gradually disappeared. At 12-month follow-up, there was no recurrence of the mass. Findings in a histological examination of the excised limbal lesion were consistent with those of limbal papilla of VKC. CONCLUSION: In recalcitrant cases of limbal VKC, in which the symptoms are apparently caused by an elevated limbal mass, surgical excision of the limbal mass can be one of the therapeutic modalities, and it may facilitate resolution of the symptoms caused by chronic limbal VKC.     

Diurnal variation of human corneal curvature in young adults

PURPOSE: To elucidate the diurnal variation of human corneal curvature with regard to gender and menstrual cycle. METHODS: Changes in corneal curvature and intraocular pressure (IOP) were measured over 24 hours in 14 young adults using corneal topography and a non-contact tonometer. In study 1, seven males and seven females (after menses) were measured. In study 2, four females out of the seven volunteers who participated in study 1 were measured again during menses. RESULTS: The females after menses showed a remarkable diurnal variation throughout 24 hours. A significant difference between the light-wake periods and dark-sleep periods of 0.83 +/- 0.15 D was found (P < .01). Corneal curvature was significantly flatter during menses than after menses in the light-wake period (P < .05). In the males, no significant diurnal change (0.21 +/- 0.12 D) was measured in corneal curvature. CONCLUSIONS: Diurnal variation of corneal curvature was significant, approximately 0.83 D in young females after menses, and corneal curvature became flatter during menses in young females. Diurnal variation of corneal curvature is an important parameter for planning refractive surgery and contact lens wear.