Glomus tumor of a female breast: a case report and review of the literature

Glomus tumor is a benign, subcutaneous neoplasm which usually arises in areas that are rich in glomus bodies, most commonly the digital area, and usually appears as a painful nodule. Glomus tumor of the breast is extremely rare, and there has been only limited information reported in the literature to date. We herein present a case of a glomus tumor arising from the breast, showing a well-circumscribed, hypervascular, solid and hypoechoic tumor within the retromammary fat. The tumor was resected and the patient’s pain was relieved immediately after the surgery. She remains well without any symptoms after a year. This report describes a unique case of this type of tumor.     

Intracoronary radiation to treat in-stent restenosis in six cardiac transplant patients.

Transplant vasculopathy significantly limits the survival of cardiac transplant patients and occurs in 50% of patients by 5 years posttransplant. We report our experience with six cardiac transplant patients who underwent intracoronary brachytherapy for in-stent restenosis. At four centers, six patients underwent intracoronary radiation for in-stent restenosis. All patients received extended antiplatelet therapy with clopidogrel and aspirin. Follow-up angiography was performed in all patients. Two of the six patients underwent subsequent target lesion revascularization. Patient 1 presented with total occlusion of her radiated lesion. She had a complex procedure requiring stenting for a dissection after the radiation dwell. Patient 2 had high-grade restenosis following brachytherapy. Patient 3 had a 50% restenotic lesion. Patients 4, 5, and 6 had follow-up angiography that showed no evidence of restenosis. There are few good options to treated accelerated transplant vasculopathy. Radiation therapy may be a viable option in this difficult patient population.     

Factors affecting complete resection of gastric tumors by the endoscopic mucosal resection procedure

BACKGROUND: In Japan, endoscopic mucosal resection (EMR) has been widely used as a treatment option for small early gastric cancer (EGC). The present study reviewed 178 cases for the 10-year period 1987-1997 in order to clarify the factors affecting the successful outcome of EMR. METHODS: Logistic regression analysis was used to examine whether complete resection of EGC correlated with the patient's age, gender, the characteristics of the tumor (location, macroscopic form, and size), the duration of the procedure and the experience of the doctor. RESULTS: The location of the tumor and the duration of the procedure correlated with the completeness of the resection (P < 0.01 and P < 0.05, respectively). Endoscopic mucosal resection was more difficult to perform for tumors in the gastric body than in the antrum or incisura region, and the longer the procedure the less complete the resection. CONCLUSION: The outcome of EMR is affected significantly by the location of the EGC.     

Regulation of human B lymphopoiesis by the transforming growth factor-beta superfamily in a newly established coculture system using human mesenchymal stem cells as a supportive microenvironment

OBJECTIVES: To characterize and evaluate the validity of a novel coculture system for studying human B-lymphocyte developmental biology. MATERIALS AND METHODS: We developed a long-term culture system to produce B lymphocytes from human CD34(+) cells purified from umbilical cord blood using human mesenchymal stem cells (hMSC) as stroma. We evaluated the effects of several low molecular weight inhibitors, recombinant proteins, and neutralizing antibodies (Abs) as potential regulators of B-lymphocyte development. RESULTS: Our cocultures of 2000 CD34(+) cells in the presence of stem cell factor and Flt3-ligand produced 1-5 x 10(5) CD10(+) cells after 4 weeks of culture. Surface IgM(+) immature B cells began to appear after 4 weeks. We evaluated the negative-regulatory effects of the transforming growth factor (TGF)-beta superfamily on human B lymphopoiesis, and found that adding an anti-activin A antibody enhanced generation of CD10(+) cells two- to three-fold. As well, the proportion of CD10(+) cells in the generated cells increased markedly, indicating that activin A downregulated B lymphopoiesis more efficiently than myelopoiesis. Addition of TGF-beta1 suppressed B-lymphocyte production by 20% to 30%, while addition of an anti-bone morphogenetic protein (BMP)-4 antibody or recombinant BMP-4 had no effect. Therefore, the strength of ability to suppress human B lymphopoiesis seemed to be activin A > TGF-beta1 > BMP-4. None of these three factors influenced the emergence of IgM(+) cells. CONCLUSIONS: hMSC coculture supported human B lymphopoiesis. Activin A selectively suppressed B lymphocyte production.     

Spinal cord ischemia after endovascular aortic repair versus open surgical repair for descending thoracic and thoracoabdominal aortic aneurism

Purpose

Thoracic endovascular aortic repair (TEVAR) an emerging less invasive alternative to surgery, is now being increasingly employed, but spinal cord ischemia (SCI) is still a threat with this procedure. Delayed paraplegia has been frequently observed after TEVAR, suggesting there may be different courses of SCI between TEVAR and the conventional open surgical repair (OSR) of thoracic and thoracoabdominal aneurysms. Therefore, we conducted a study to investigate the risk factors for and the course of SCI after TEVAR and OSR.

Methods

We studied a series of 414 OSR and 94 TEVAR patients prospectively. Postoperative motor function, sensory disturbance, and bladder disturbance were assessed daily to evaluate the course of SCI. Previously reported risk factors for SCI were investigated.

Results

Spinal cord ischemia occurred in 6 patients (6.4 %) in the TEVAR group, and in 18 patients (4.3 %) in the OSR group, resulting in no significant difference (p = 0.401). A greater percentage of patients (n = 4, 66.7 %) with SCI in the TEVAR group had a delayed onset, compared with 16.7 % (n = 3) in the OSR group (p = 0.038). The rate of recovery of walking function after SCI and the incidence of sensory disturbance and bladder dysfunction was similar in the two groups. Multivariate analysis demonstrated that, in the TEVAR group, the stent length of aortic coverage was a significant risk factor for SCI.

Conclusion

The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in the TEVAR group. Except for the delayed onset of SCI, SCI showed a similar course of recovery in the two groups.     

Periurethral injection of autologous adipose‐derived regenerative cells for the treatment of male stress urinary incontinence: Report of three initial cases

Objectives: To report a novel cell therapy using autologous adipose tissue‐derived regenerative cells for male stress urinary incontinence caused by urethral sphincteric deficiency, and the outcomes in the initial cases undergoing periurethral injection of adipose tissue‐derived regenerative cells. Methods: Three patients with moderate stress incontinence after radical prostatectomy and holmium laser enucleation of the prostate were enrolled. Adipose tissue‐derived regenerative cells were isolated from the abdominal adipose tissue by using the Celution system. Subsequently, the isolated adipose tissue‐derived regenerative cells, and a mixture of adipose tissue‐derived regenerative cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Short‐term outcomes during a 6‐month follow up were assessed by a 24‐h pad test, a validated patient questionnaire, urethral pressure profile, transrectal ultrasonography and magnetic resonance imaging. Results: Urinary incontinence progressively improved after 2 weeks of injection up to 6 months in terms of decreased leakage volume, decreased frequency and amount of incontinence, and improved quality of life. Both maximum urethral closing pressure and functional profile length increased. Magnetic resonance imaging suggested a sustained presence of the injected adipose tissue. Enhanced ultrasonography showed a progressive increase in the blood flow to the injected area. No significant adverse events were observed peri‐ and postoperatively. Conclusion: These preliminary findings suggest that periurethral injection of the autologous adipose tissue‐derived regenerative cells is a safe and feasible treatment modality for male stress urinary incontinence.     

Nox3-Derived Superoxide in Cochleae Induces Sensorineural Hearing Loss

Reactive oxygen species (ROS) produced by NADPH oxidases (Nox) contribute to the development of different types of sensorineural hearing loss (SNHL), a common impairment in humans with no established treatment. Although the essential role of Nox3 in otoconia biosynthesis and its possible involvement in hearing have been reported in rodents, immunohistological methods targeted at detecting Nox3 expression in inner ear cells reveal ambiguous results. Therefore, the mechanism underlying Nox3-dependent SNHL remains unclear and warrants further investigation. We generated Nox3-Cre knock-in mice, in which Nox3 was replaced with Cre recombinase (Cre). Using Nox3-Cre;tdTomato mice of either sex, in which tdTomato is expressed under the control of the Nox3 promoter, we determined Nox3-expressing regions and cell types in the inner ear. Nox3-expressing cells in the cochlea included various types of supporting cells, outer hair cells, inner hair cells, and spiral ganglion neurons. Nox3 expression increased with cisplatin, age, and noise insults. Moreover, increased Nox3 expression in supporting cells and outer hair cells, especially at the basal turn of the cochlea, played essential roles in ROS-related SNHL. The extent of Nox3 involvement in SNHL follows the following order: cisplatin-induced hearing loss > age-related hearing loss > noise-induced hearing loss. Here, on the basis of Nox3-Cre;tdTomato, which can be used as a reporter system (Nox3-Cre^+/−;tdTomato^+/+ and Nox3-Cre^+/+;tdTomato^+/+), and Nox3-KO (Nox3-Cre^+/+;tdTomato^+/+) mice, we demonstrate that Nox3 inhibition in the cochlea is a promising strategy for ROS-related SNHL, such as cisplatin-induced HL, age-related HL, and noise-induced HL.SIGNIFICANCE STATEMENT We found Nox3-expressing regions and cell types in the inner ear, especially in the cochlea, using Nox3-Cre;tdTomato mice, a reporter system generated in this study. Nox3 expression increased with cisplatin, age, and noise insults in specific cell types in the cochlea and resulted in the loss (apoptosis) of outer hair cells. Thus, Nox3 might serve as a molecular target for the development of therapeutics for sensorineural hearing loss, particularly cisplatin-induced, age-related, and noise-induced hearing loss.     

The gastrocnemius with soleus bi-muscle flap.

The gastrocnemius muscle flap is often insufficient in volume and arc of rotation for coverage of a large soft tissue defect of the knee and the upper third of the leg. Therefore we developed a new concept of the flap which combines soleus and gastrocnemius muscles, named the 'gastrocnemius with soleus bi-muscle flap'. In 16 cadavers we studied the location and number of perforators, which penetrate the gastrocnemius muscle through the soleus muscle. In all cases perforators were found in the distal half of the gastrocnemius muscle. Angiography in one fresh cadaver confirmed that the soleus muscle could receive the reversed flow from the gastrocnemius muscle perforators. We subsequently treated a patient with exposed proximal tibia with this flap. This flap is useful to cover a large soft tissue defect of the knee and the upper third of the leg.