Posterior interosseous nerve injury complicating ulnar osteotomy for a missed Monteggia fracture.

We describe a 6-year-old boy with a posterior interosseous nerve injury after an ulnar osteotomy for a chronic Monteggia lesion. Although the first consultant did an ulnar osteotomy to reduce the radial head, the posterior interosseous nerve palsy did not recover. Next we found that the posterior interosseous nerve had been drawn into the radiocapitellar joint. It is important to confirm interposition of the nerve at the radiocapitellar joint during corrective osteotomy for a chronic Monteggia lesion.     

铁皮石斛试管苗快速繁殖的研究

兰科植物铁皮石斛(Dendrobium candidum Wall.ex Lind1.)的茎为常用名贵中药。多年来,主要依靠采收野生品种供药用和出口,致使野生资源枯竭,现已成为日益稀少的濒危植物。兰属种子和石斛属种子试管繁殖已积累不少资料,但是有关铁皮石斛种子试管繁殖的研究只有少量简单的报道,对其种子在试管繁殖过程中,所需外界条件的研究也不够     

Cardiomyopathy Characterized by Abnormal Accumulation of Desmin-type Intermediate Filaments in Cardiac Muscle Fibers: A Case Report and Review of the Literature

A 42 year old Japanese male, who had been suffering from congestive heart failure and electrocardiographic abnormalities (A V block, intraventricular conduction disturbance, ventricular tachycardia), died after a clinical course of 2 years and 1 month. Macroscopic investigation revealed dilation of the left ventricle and thickening of the right ventricular wall. The unique finding in this case was a circumferential fibrous scar in the median circular layer and outer oblique layer of the left ventricular wall. Biopsy and autopsy materials revealed diffuse loss of myofibrils in the central zone of cardiac muscle fibers, and replacement with aniline blue positive homogeneous material (17–35% of the area of one muscle fiber). Electron microscopy revealed abnormal accumulation of fine filamentous material (7.5–25 nm in diameter), which was immunohisto-chemically proved to be desmin type intermediate filament. Moreover, sarcoplasmic reticulum like material was detected in the degenerated area. At autopsy, degeneration was detected all over the heart. The ventricular muscle fibers were more severely affected than the atrial muscle fibers. The conduction system was also affected, in some parts more severely than the surrounding ordinary muscle fibers. The pathogenesis of this disorder remains to be clarified. Acta Pathol Jpn 39: 266–273, 1989.     

AN AUTOPSY CASE OF DIFFUSE MYELOMATOSIS ASSOCIATED WITH SYSTEMIC KAPPA LIGHT CHAIN DEPOSITION DISEASE (LCDD) A Patho-anatomical, Immunohistochemical and Immunobiochemical Study

A case of systemic light chain deposition disease in a 48-year-old man is presented. Clinically, the patient showed the signs of multiple organ (liver, heart and kidney) failure, but multiple myeloma was not diagnosed. Autopsy revealed generalized deposition of hyaline, a Congo red-negative substance, especially in the arterial walls of various organs. In the bone marrow, myelomatous proliferations of plasma cells positive for kappa light chain were recognized. The deposited substance was ultrastructurally different from amyloid fibrils, and was identified as kappa light chain by immunohistochemistry. A liver tissue extract was immunobiochemically examined and the deposited substance was confirmed to consist of kappa light chain, its molecular weight being approximately 14,000 to 17,000 Da.     

A resectable case of gastrointestinal stromal tumor derived from the rectal wall after oral targeted molecular therapy with imatinib mesylate

We performed targeted molecular therapy in a patient with a non-resectable pelvic gastrointestinal stromal tumor (GIST). Imatinib mesylate was administered at 400-600 mg/day for 6 months, and the tumor became resectable. The patient was a 58-year-old female who visited a gynecologic hospital with the chief complaint of a swollen feeling in the lower abdomen. A pelvic tumor was found by imaging, and the patient was referred to our hospital. Laparotomy was performed, but it was found that the tumor arose from the intestinal serous membrane, rather than from the uterus, and complete excision was difficult. A portion of the tumor tissue was excised, and the abdomen was closed. GIST was diagnosed on postoperative pathological examination, and the tissue was positive for c-kit protein on immunostaining. The tumor had markedly shrunk after oral administration of imatinib mesylate for 6 months, and excision by laparotomy became possible.     

Case of uterine cervical carcinosarcoma

Carcinosarcoma (CS) is a rare neoplasm that is called a mixed epithelial and mesenchymal malignancy. CS of the uterine cervix is much less common than its counterparts in the uterine corpus. A 61-year-old, gravida 2, para 2 woman, who had undergone menopause 16 years prior to the presentation, was diagnosed with CS of the uterine cervix. A semiradical hysterectomy was carried out on the diagnosis of stage Ib1 cervical cancer. The patient underwent whole pelvic 45 Gy radiation as a postoperative additional treatment, but she died from multiple organ failure by metastasis 17 months after the operation. The tumor protruded from the cervix to the vagina and measured 4.5 x 3.0 cm. Histologically, the tumor was characterized as a squamous cell carcinoma and mesenchymal malignancy, represented by osteosarcomatous components. The stroma was largely composed of atypical spindle-shaped cells, which were immunohistochemically demonstrated to be of epithelial origin. Uterine cervical CS is one of the aggressive malignancies, and squamous cell carcinomas are common epithelial counterparts of cervical CS as well as adenocarcinomas.