miR‐424 levels in hair shaft are increased in psoriatic patients

Objective diagnostic markers have not been in clinical use for psoriasis. In this study, we investigated the levels of miR‐424 in hair roots and hair shafts in psoriatic patients, and evaluated the possibility that miR‐424 can be a biomarker of the disease. A single hair root and five pieces of hair shafts (~5 cm in length) were obtained from the non‐lesional occiput of each individual of 26 psoriatic patients. Control hair samples were collected from nine normal subjects. Samples from 10 atopic dermatitis patients were also included as the disease control. miR‐424 levels were determined by quantitative real‐time polymerase chain reaction. Hair shaft miR‐424 levels were significantly upregulated only in patients with psoriasis compared with normal controls and those with atopic dermatitis. By receiver–operator curve analysis of hair shaft miR‐424 to distinguish psoriatic patients from normal subjects, the area under the curve was 0.77. However, relative miR‐424 levels were not correlated with disease activity markers including disease duration, body surface area and Psoriasis Area and Severity Index. Hair root miR‐424 was not useful for evaluating both diagnosis and severity of the disease. Our results indicated hair shaft miR‐424 levels may be useful as a diagnostic marker of psoriasis.     

Synovitis of the wrist caused by Mycobacterium florentinum

Mycobacterium florentinum is a newly identified, rare, slow-growing species of nontuberculous mycobacteria (NTM). Here, we report a case of M. florentinum-induced synovitis of the wrist in an immunocompromised Japanese patient. M. florentinum was identified by sequence analysis of the rpoB, hsp65, and 16S rRNA genes. The M. florentinum strain in this study could not be differentiated from certain M. triplex strains by the hsp65 or 16S rRNA sequences alone, because they occasionally shared more than 99 % sequence identity. The isolated M. florentinum strain was only susceptible to clarithromycin and amikacin. Initially, the patient was treated with clarithromycin, levofloxacin, and ethambutol, and then with clarithromycin, levofloxacin, and rifampicin. To our knowledge, M. florentinum-induced synovitis has not been previously reported. Our results suggest that, in addition to other well-known pathogenic NTM, the recently identified M. florentinum strain should be considered as a possible cause of synovitis. Moreover, we should be cautious when identifying M. florentinum because this strain closely resembles M. triplex in genotype.     

Mixed gonadal dysgenesis with seminoma: a case report

A case of mixed gonadal dysgenesis with anaplastic seminoma is reported. A 43-year-old, female, who was brought up as a female, was admitted to our hospital for swelling of left inguinal region. The physical examination revealed a short stature, ambiguous external genitalia but no Turner's stigmata. A child's head-sized tumor was noticed in the left inguinal region by CT scan. The histopathological diagnosis of this tumor was anaplastic seminoma. The right gonad was removed at laparotomy with lymph node dissection in the pelvis. Histological examination of right gonad revealed streak gonad and immature uterine with fallopian tube. In the Japanese literature, 7 cases including our case of mixed gonadal dysgenesis with gonadal tumor have been reported.     

Long-term results of cerebral arteriovenous malformations--surgical and conservative treatment

During the past 20 years, we have treated 187 cases with cerebral arteriovenous malformations (AVMs). These 134 patients were treated surgically and the remaining 53 patients were managed non-surgically. The purpose of this study is to clarify the surgical indications of AVMs, based on a comparison of the long-term follow-up results between the surgical and nonsurgical groups. Consequently, good results were obtained in the surgical group: the operative mortality was 7.5% and the morbidity was 12.7%. The long-term follow-up results were as follows: Of the 124 followed cases in the surgical group, there were 16 cases with improvement of neurological deficits (13%) and 3 cases with neurological aggravation (2%). Of the 47 followed cases in the nonsurgical group, there were 5 cases with improvement of neurological deficits (11%) and 6 cases with neurological aggravation (13%). As for the incidence of AVM hemorrhage, there were 8 cases with hemorrhage in the nonsurgical group including 4 cases (3 rebleeding cases) which were fatal (11%), in contrast to one case (subtotal resection) in the surgical group. On follow-up angiography, the size of AVMs were unchanged in the majority of cases in the nonsurgical group, with the exception of 2 cases in which there were slight regressions. In the surgical group, on the other hand, enlargement in 2 cases and spontaneous regression in 3 of residual AVM occurred following incomplete resection. Particularly in 2 cases involving unresectable AVMs, a newly formed aneurysm was discovered in the follow-up angiography, emphasizing the fact that serious follow-up angiography is required in cases of untreated AVMs.     

Immunohistochemical analysis of Ki-67, p53, p21, and p27 in benign and malignant apocrine lesions of the breast: its correlation to histologic findings in 43 cases.

We examined Ki-67, p53, p21, and p27 immunolocalization in 43 cases of apocrine lesions of the breast and correlated these findings with histologic parameters to understand their biologic significance. Twenty cases were benign, 1 case was borderline, and 22 cases were diagnosed as malignant, including 9 intraductal and 13 invasive apocrine carcinomas. Both the ratio of Ki-67-positive cases (17 of 21 [88.9%] versus 1 of 19 [5.3%]; P < .001) and the Ki-67 labeling index of positive cases examined (15.0% versus 2.7%; P < .005) were significantly higher in malignant than in benign apocrine lesions. None of the benign or borderline cases was immunohistochemically positive for p53, but 15 of 22 malignant cases (68.2%) demonstrated p53 (P < .001). In addition, the ratio of p53-positive cases was significantly higher in high nuclear grade cases (11 of 13 [84.6%]) than in intermediate nuclear grade cases (4 of 9 [44.4%]; P < .05). P53 immunoreactivity was also positively correlated with the nuclear grade of carcinoma cases examined in this study. Neither p21 nor p27 demonstrated any correlation with histologic parameters or findings of the apocrine lesions. Results of these studies suggest that Ki-67 and p53 may be good markers for differentiation between benign and malignant breast apocrine lesions.     

Correlation between pain and dysfunction and intra-articular adhesions in patients with internal derangement of the temporomandibular joint.

The correlation between pain and dysfunction scores obtained by questionnaire and an adhesions index obtained via arthroscopic inspection was investigated in 28 patients with internal derangements (closed lock) of the temporomandibular joint (TMJ). A weak correlation was found between pain scores and the adhesions index. However, joint noise had a negative correlation with both severity and distribution of adhesions in the TMJ. A weak, but statistically significant, negative correlation also was found between the degree of interincisal opening and the adhesions index. This study indicates that intra-articular adhesions are one of the factors contributing to limited mouth opening in patients with closed lock, but that they do not cause TMJ pain.     

A case report of ascending-abdominal aorta bypass in the treatment of atypical coarctation

A 45-year-old woman, who had atypical coarctation of the aorta due to aortitis syndrome, underwent ascending-infrarenal abdominal aorta bypass successfully. A woven dacron prosthesis of 14 mm in diameter was anastomosed to the ascending aorta. The course of the graft arranged to pass through a hole cut into the diaphragm across the omental sac behind the pancreas to the infrarenal abdominal aorta. This operation is approached through a midline sternal-splitting and abdominal incision, accordingly pulmonary complication and injury to major collateral vessels associated with lateral thoracotomy can be avoided.     

Surgical management of renal cell carcinoma extended into the vena cava and the right atrium

The present report describes two cases of renal cell carcinoma extending into the vena cava and the right atrium. The treatment was total nephrectomy and tumor thrombectomy, utilizing extracorporeal circulation. The aggressive surgical management of this progressive malignant disease is discussed.