Panretinal photocoagulation with simultaneous cryoretinopexy or intravitreal bevacizumab for neovascular glaucoma

Background

To compare the therapeutic effects of panretinal photocoagulation (PRP) combined with intravitreal bevacizumab (IVB) and cryoretinopexy (CR-IVB) to that of PRP combined with IVB alone in eyes with neovascular glaucoma (NVG).

Design

Retrospective, consecutive, case-control study.

Methods

The medical records of 102 eyes of 96 patients with NVG due to proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome were reviewed. The mean age of the patients was 59.6?±?11.5 years, with a range of 34 to 84 years. Patients received either 1.25 mg/0.05 ml of IVB combined with 360° of cryotherapy of the peripheral retina (CR-IVB subgroup) or IVB alone (IVB alone subgroup) as adjunctive treatments to PRP. The patients were followed for at least 12 months. Fifty-four eyes of 49 patients had open-angle NVG; 30 of these eyes were treated by CR-IVB, and 24 eyes by IVB alone. Forty-eight eyes of 48 patients had angle-closure NVG; 22 of these eyes were treated by CR-IVB, and 26 eyes were by IVB alone. Failure was defined as a postoperative intraocular pressure (IOP) >21 mmHg for two consecutive follow-up visits, or the need of additional surgery such as trabeculectomy or diode laser cycloablation. The differences in the success rates between the CR-IVB and IVB alone subgroups for the eyes with open-angle and closed-angle NVG were compared.

Results

The success rate at 12 months in eyes with open-angle NVG was 80.0 % in the CR-IVB subgroup and 41.7 % in the IVB alone subgroup (P?=?0.0096). In eyes with angle-closure NVG, the success rate at 12 months was 22.7 % in the CR-IVB subgroup and 0 % in the IVB-alone subgroup (P?=?0.030).

Conclusion

The significantly better IOP control after PRP combined with cryotherapy and IVB than after PRP with IVB alone indicates that cryotherapy enhances the effectiveness of PRP for neovascular glaucoma for at least 1 year.     

Malignant parotid gland tumors and facial nerve paralysis

Summary During the last three decades, 586 cases of parotid gland tumor have been extirpated in our clinic. The tumors were malignant in 170 cases and, of these, facial nerve paralysis was observed at first examination in 59 patients. This paper deals with the retrospective study of these cases and is chiefly concerned with the histological types and facial nerve paralysis.     

A case of pancreatic serous cystadenoma with obstructive jaundice

A 62‐year‐old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall‐bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule‐like low‐density area measuring 2.0 × 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 × 2.7 × 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.     

ENDOSONOGRAPHIC CLASSIFICATIONS OF GASTROINTESTINAL SUBMUCOSAL TUMORS

Aim : The aim of this study was to classify the endosonographic features of gastrointestinal submucosal tumors. Methods : The endosonographic and clinicopathologic findings of 302 submucosal elevated lesions from 295 patients were compared. Results : Endoscopic ultrasound was able to clearly demonstrate the anatomical layer origin of the lesions. The internal echo patterns of the submucosal tumors could be categorized into seven types consisting of simple cystic (I), multicystic (II), solid cystic (III), hyperechoic (IV), isoechoic (V), hypoechoic (VI), and mixed solid (VII). Cysts, lymphangioma, and lipoma were characterized as type I, II, and IV images, respectively. Brunner’s gland hamartoma and heterotopic gastric mucosa showed various patterns of cystic and solid echoes (I–VII). Inflammatory fibroid polyps, granular cell tumors, and carcinoid tumors often manifested type VI images. Malignant tumors, particularly leiomyosarcoma, tended to show VII images. Conclusions : The endosonographic classification is considered to be important in the diagnosis of gastrointestinal submucosal elevated lesions.     

Cardiac energetics analysis after aortic valve replacement with 16-mm ATS mechanical valve

The 16-mm ATS mechanical valve is one of the smallest prosthetic valves used for aortic valve replacement (AVR) in patients with a very small aortic annulus, and its clinical outcomes are reportedly satisfactory. Here, we analyzed the left ventricular (LV) performance after AVR with the 16-mm ATS mechanical valve, based on the concept of cardiac energetics analysis. Eleven patients who underwent AVR with the 16-mm ATS mechanical valve were enrolled in this study. All underwent echocardiographic examination at three time points: before AVR, approximately 1 month after AVR, and approximately 1 year after AVR. LV contractility (end-systolic elastance [Ees]), afterload (effective arterial elastance [Ea]), and efficiency (ventriculoarterial coupling [Ea/Ees] and the stroke work to pressure–volume area ratio [SW/PVA]) were noninvasively measured by echocardiographic data and blood pressure measurement. Ees transiently decreased after AVR and then recovered to the pre-AVR level at the one-year follow-up. Ea significantly decreased in a stepwise manner. Consequently, Ea/Ees and SW/PVA were also significantly improved at the one-year follow-up compared with those before AVR. The midterm LV performance after AVR with the 16-mm ATS mechanical valve was satisfactory. AVR with the 16-mm ATS mechanical valve is validated as an effective treatment for patients with a very small aortic annulus. The cardiac energetics variables, coupling with the conventional hemodynamic variables, can contribute to a better understanding of the patients’ clinical conditions, and those may serve as promising indices of the cardiac function.     

Molecular–genetic and clinical characteristics of gliomas with astrocytic appearance and total 1p19q loss in a single institutional consecutive cohort

The prognostic significance of 1p19q loss in astrocytic gliomas has been inconclusive.We collected 57 gliomas with total 1p19q loss from among 218 cases of WHO grade-II/III gliomas operated at Keio University Hospital between 1990 and 2010. These tumors were classified as oligodendroglial or “astrocytic” by a WHO-criteria-based institutional diagnosis. Chromosomal copy number aberrations (CNAs), IDH 1/2 mutations, MGMT promoter methylation, and expression of p53 and ATRX were assessed. Survival outcome was compared between the two histological groups.Of the 57 codeleted gliomas, 37, 16, and four were classified as oligodendroglial, “astrocytic”, and unclassified, respectively. Comparative genomic hybridization revealed that although chromosome 7q/7 gain was more frequent in “astrocytic” gliomas, other CNAs occurred at a similar frequency in both groups. None of the “astrocytic” gliomas showed p53 accumulation, and ATRX loss was found in three of the 15 “astrocytic” gliomas. The estimated overall survival (OS) curves in the patients with codeleted oligodendroglial and “astrocytic” gliomas overlapped, and the median OS was 187 and 184 months, respectively. Histopathological re-assessment by a single pathologist showed consistent results.Gliomas with total 1p19q loss with “astrocytic” features have molecular and biological characteristics comparable to those of oligodendroglial tumors.     

Clinicopathological multiplicity of dementia with Lewy bodies

‘Dementia with Lewy bodies (DLB)’ is a generic clinicopathological concept characterized by progressive dementia and Lewy bodies (LB). We examined 23 autopsied DLB cases clinicopathologically and immunohistochemically. These cases were classified into the neocortical type (10 cases), the limbic type (seven cases), the cerebral type (one case) and the brainstem type (none) according to our pathological criteria, which were based on the regional incidence of LB and the degree of neuronal loss in the substantia nigra. Each subtype of DLB was further divided into the common form and the pure form on the basis of the degree of Alzheimer pathology. The remaining five cases were not classified by our pathological criteria, and were designated ‘the senile dementia of Alzheimer type (SDAT) or Alzheimer's disease (AD) type of DLB with neocortical or limbic LB’. We examined how each subtype was correlated with various clinical features, such as the age of disease onset, the clinical duration, the degree of dementia, and the presence or absence of parkinsonism, fluctuating cognition and visual hallucination. The results of this study indicate that DLB can be clinicopathologically divided into a number of subtypes, that each subtype is preferentially correlated with some clinical feature, and that the neocortical type, common form, is the major type of DLB.     

Investigation of inflammation inducing substances in PM2.5 particles by an elimination method using thermal decomposition

The substances associated with PM2.5‐induced inflammatory response were investigated using an elimination method. PM2.5 were heated at temperatures of 120, 250, and 360°C. The results demonstrated microbial substances such as LPS and b‐glucan, and chemicals including BaP, 1,2‐NQ, and 9,10‐PQ were reduced drastically in PM2.5 heated at 120°C. On the other hand, DBA, 7,12‐BAQ, and BaP‐1,6‐Q were not noticeably reduced. Most of these substances had disappeared in PM2.5 heated at 250°C and 360°C. Metals (eg, Fe, Cu, Cr, Ni) in PM2.5 exhibited a slight thermo‐dependent increase. RAW264.7 macrophages with or without NAC were exposed to unheated PM2.5, oxidative stress‐related and unrelated inflammatory responses were induced. PM2.5‐induced lung inflammation in mice is caused mainly by thermo‐sensitive substances (LPS, b‐glucan, BaP, 1,2‐NQ, 9,10‐PQ, etc.). Also, a slight involvement of thermo‐resistant substances (DBA, 7,12‐BAQ, BaP‐1,6‐Q, etc.) and transition metals was observed. The thermal decomposition method could assist to evaluate the PM2.5‐induded lung inflammation.