Nonoperative management of major blunt renal lacerations with urinary extravasation: report of two cases

Two cases of major blunt renal trauma with urinary extravasation managed by conservative treatment are presented herein. The first case: A 13-year-old girl fell from a bicycle. A computed tomographic (CT) scan showed right renal laceration with retroperitoneal hematoma. Renal arteriography showed evidence of fresh arterial bleeding without visualization of the lower pole. She was treated conservatively with superselective arterial embolization of the lower pole. She developed no urinoma with normal renal function. Renal renin and blood pressures stayed within the normal range in follow up studies. The second case: A 12-year-old boy fell from a tree and hit his right flank. A CT scan showed fragmentation of right renal cortex with retroperitoneal hematoma. He was treated conservatively as his vital signs remained stable, no active arterial bleeding was found no renal arteriography and both renal pelvis and ureters were well visualized by intra venous pyelography. Retroperitoneal hematoma was absorbed without formation of urinoma. Renal function remained within normal limits in follow up studies.     

Long thoracic nerve paralysis associated with thoracic outlet syndrome

Two cases of long thoracic nerve palsy associated with thoracic outlet syndrome are reported. Both patients had abnormal posture, with low-set shoulders and winged scapulae. Clinically there was weakness of the serratus anterior muscle with partial denervotion on electromyography. The diagnosis of thoracic outlet syndrome was based on positive vascular tests and brachial plexus nerve compression symptoms induced by the vascular testing positions. An orthosis that held the shoulder in an elevated position was used in both cases. Complete recovery of shoulder function and relief of the symptoms was achieved in both cases at 8 and 13 months, respectively, after application of the orthosis.     

The role of estrogen-metabolizing enzymes and estrogen receptors in human epidermis

Local estrogen metabolism and its sensitivities in the skin have been also suggested to contribute to skin homeostasis in addition to age- and/or gender-dependent circulating estrogen, even though their local mechanisms have been largely unknown. To characterize their potential correlations, age- and gender-dependencies were evaluated focusing on 5 pivotal estrogen-metabolizing enzymes including aromatase, estrogen sulfotransferase, steroid sulfatase, and 17β-hydroxysteroid dehydrogenases and estrogen receptors (ERα and ERβ) using immunohistochemistry of 100 human skin specimens. When their epidermal expression levels were compared among 7 age groups, ranging from the teens to the seventies, the highest expression in the teens group and the lowest expression in the seventies group were found in the expression of aromatase and ERβ, respectively, while no significant differences between the male and the female groups were found in the immunoreactivities of our interested proteins. Our results suggest that age-related differences in aromatase and ERβ expressions impact epidermal homeostasis.     

Effect of simulated pulpal pressure on all-in-one adhesive bond strengths to dentine

OBJECTIVES: To evaluate the durability of all-in-one adhesive systems bonded to dentine with and without simulated hydrostatic pulpal pressure (PP). METHODS: Flat dentine surfaces of extracted human molars were prepared. Two all-in-one adhesive systems, One-Up Bond F (OBF) (Tokuyama Corp., Tokyo, Japan), and Fluoro Bond Shake One (FBS) (Shofu Co., Kyoto, Japan) were applied to the dentine surfaces under either a PP of 0 or 15cm H(2)O. Then, resin composite build-ups were made. The specimens bonded under pressure were stored in 37 degrees C water for 24h, 1 and 3 months under 15cm H(2)O PP. Specimens not bonded under pressure were stored under zero PP. After storage, the specimens were sectioned into slabs that were trimmed to hourglass shapes and subjected to micro-tensile bond testing (muTBS). The data were analysed using two-way ANOVA and Holm-Sidak HSD multiple comparison tests (alpha=0.05). RESULTS: The muTBS of OBF fell significantly (p<0.05) when PP was applied during bonding and storage, regardless of storage time. In contrast, although the muTBS of OBF specimens bonded and stored without hydrostatic pressure storage fell significantly over the 3 months period, the decrease was less than half as much as specimens stored under PP. In FBS bonded specimens, although there was no significant difference between the muTBS with and without hydrostatic pulpal pressure at 24h, by 1 and 3 months of storage under PP, significant reductions were seen compared with the control group without PP. CONCLUSION: The muTBS of OBF bonded specimens was lowered more by simulated PP than by storage time; specimens bonded with FBS were not sensitive to storage time in the absence of PP, but showed lower bond strengths at 1 and 3 months in the presence of PP.     

Iterative surgical resections for second primary and local recurrent lung cancer; comparison of lobectomy and limited resection

During a 24-year period (1986-2009), 74 patients (3.5%) underwent iterative surgical resections for 2nd primary and recurrent lung cancer. Patients are classified to 5 groups: 20 2nd primary lung cancer patients undergoing lobectomy (A), 24 2nd primary lung cancer patients undergoing limited resection (B), 11 2nd primary bronchioloalveolar carcinoma (BAC) patients undergoing limited resection (C), 8 recurrent lung cancer patients undergoing lobectomy (D), and 11 recurrent lung cancer patients undergoing limited resection (E). There were 13 (65%) patients with pathological stage IA in group A, 20 (83%) in B, 11 (100%) in C, 2 (25%) in D, and 8 (73%) in E. There were 18 (90%) patients with adenocarcinoma in group A, 15 (63%) in B, 11 (100%) in C, 5 (63%) in D, and 9 (82%) in E. Overall hospital mortality was 5%, including 3 deaths in A and 1 death in D. Five-year and 10-year survival after the 2nd surgery was 55% and 55% in A, 63% and 50% in B, 100% and 100% in C, 57% and 37% in D, and 70% and 53% in E. These data showed that limited resections had low surgical risk and good long-term results. Limited resection appears to achieve better outcomes for 2nd primary and recurrent lung cancer and should be chosen whenever possible.     

The combination of cisplatin and vinorelbine with concurrent thoracic radiation therapy for locally advanced stage IIIA or IIIB non-small-cell lung cancer

Aims: The aims of this study were to assess the efficacy and toxicity of concurrent chemoradiotherapy with divided schedule of cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer (NSCLC). Methods: Patients with previously untreated, unresectable, and stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Twenty-six patients (24 men and 2 women; median age, 66 years; age range, 42–75 years) were enrolled. Both cisplatin (40 mg/m²) and vinorelbine (20 mg/m²) were given on days 1 and 8 every 3 weeks. Beginning on day 2 of chemotherapy, thoracic radiotherapy was given for approximately 6 weeks (2 Gy per fraction; total dose, 60 Gy). Results: Five of the 26 patients achieved a complete response, and 16 achieved a partial response for an overall response rate of 80.8% (95% confidence interval, 60.6–93.4%). The median survival time was 23 months (range, 4–43 months). Overall survival rates at 1 and 2 years were 80 and 56%, respectively. Hematologic toxicities included grade 3–4 neutropenia in 84.6% of patients, grade 3–4 thrombocytopenia in 3.8%, and grade 3–4 anemia in 61.5%. Two patients (7.7%) had grade 3 radiation esophagitis that resolved completely without dilation. Grade 3–4 radiation pneumonitis occurred in two patients (7.7%) and was treated with corticosteroids. Both patients had a good partial resolution of symptoms and radiographic abnormalities. There were no treatment-related deaths. The actual delivered dose intensities for both cisplatin and vinorelbine were 79.5%. Radiotherapy was completed in 96% of patients. Conclusion: Concurrent chemoradiotherapy with cisplatin and vinorelbine administered on a divided schedule is effective and well tolerated in patients with locally advanced NSCLC.     

A case of infected renal cyst extending to leg abscess

A 45-year-old woman was referred to our hospital with the chief complaint of left flank pain, left leg pain and loss of appetite. Computed tomography scan and magnetic resonance imaging demonstrated a large cystic mass in the left kidney, which we diagnosed as an infected renal cyst. Under ultrasonic guidance, percutaneous puncture and drainage of the renal cyst were performed. After her leg pain worsened, computed tomography revealed abscesses in the left leg, suggesting an infected renal cyst extending to the leg through the obturator foramen. Under general anesthesia, incision and drainage were performed. Cultures from the cyst and abscess fluid showed Klebsiella pneumoniae. Our case is the 82nd case of an infected renal cyst in the Japanese literature.     

In vitro antimicrobial activity of gatifloxacin against 873 clinical isolates from respiratory tract, urinary tract and surgical infections during 1997-1998 in Japan

The in vitro activity of gatifloxacin was determined for 873 isolates from various infections during 1997-1998 in Japan. Gatifloxacin was active against streptococci, Escherichia coli, Klebsiella pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Neisseria gonorrhoeae, with MIC(90)s of 相似文献