Steal phenomenon with kinked graft caused a loss of viability in a dialysis patient

A 74-year-old man with chronic renal failure under hemodialysis via the left upper extremity underwent an off-pump coronary artery bypass (OPCAB). The left internal thoracic artery (LITA), which was harvested in a skeletonized manner, was anastomosed to the left anterior descending artery (LAD). Postoperatively, he complained of chest pain only during dialysis. Angiography revealed a kinking in the LITA. However, myocardial scintigraphy revealed no ischemia. One year after OPCAB, left ventriculography revealed akinesis and myocardial scintigraphy revealed no viability in the anterior wall. This suggested that the viability was lost due to graft kinking and steal phenomenon during hemodialysis. If the length of the skeletonized ITA graft is redundant, kinking of the graft rarely occurs after the chest is closed. We also suggest that to avoid the kinking of the ITA graft, fibrin glue should be used to paste the ITA graft running in a gentle curve.     

A localized primary sclerosing cholangitis preoperatively diagnosed as hilar cholangiocarcinoma; report of a case

The authors report herein a case of primary sclerosing cholangitis localized to the hepatic hilum which occurred in a 67-year-old male. The direct cholangiography revealed bile duct stenosis from the common hepatic duct to bilateral hepatic ducts. We could not confirm bile duct malignancy, however, hilar cholangiocarcinoma was most suspicious. We performed right trisegmentectomy of the liver with caudate lobectomy and lymph node dissection 3 weeks after right portal embolization. Pathological findings confirmed localized primary sclerosing cholangitis. Surgical resection of the affected bile duct is most effective in localized primary sclerosing cholangitis, because the prognosis of the disease is poor and secondary carcinogenesis in primary sclerosing cholangitis has high incidence.     

Intracranial osteosarcoma after radiosurgery--case report

A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm.     

Safety and efficacy of fluvastatin in hyperlipidemic patients with chronic renal disease

BACKGROUND: There are few reports on the safety and efficacy of long-term treatment with statins in patients with chronic renal disease and hyperlipidemia. We evaluated these subjects treated with fluvastatin. METHODS: After a 4-week run-in period, a total of 80 patients with diabetic nephropathy or chronic glomerulonephritis were randomly allocated to receive dietary therapy and fluvastatin 20 mg/day (n=39), or dietary therapy alone (n=41) for a period of 48 weeks. Lipid parameters, rhabdomyolysis-related indicators, 24-hour urinary albumin excretion and creatinine clearance were measured. The pharmacokinetics of fluvastatin was examined in 8 patients. RESULTS: Creatinine clearance and 24-hour urinary albumin excretion did not differ between the two groups. The peak serum fluvastatin concentration (Cmax) was 141+/-67 microg/L and the mean AUC0-6 h was 341+/-149 microgh/L. Fluvastatin treatment significantly lowered serum total cholesterol, low-density lipoprotein (LDL) cholesterol and apo-lipoprotein B concentrations by 16%, 25%, and 22%, respectively, compared with patients receiving dietary therapy alone. There were no significant differences in serum triglyceride and high-density lipoprotein (HDL) cholesterol concentrations between the two treatment groups. Serum creatine kinase and aldolase concentrations did not change throughout treatment in both groups. CONCLUSIONS: Fluvastatin treatment significantly improved lipid parameters in patients with chronic renal disease. Fluvastatin was well tolerated, with no adverse effects on renal function and no muscular toxicity. However, the drug showed no direct renoprotective effects.     

Effect of Bisphenol A on non-specific immunodefenses against non-pathogenic Escherichia coli

We examined the effect of Bisphenol A (BPA) on non-specific defense in experiments with a non-pathogenic bacterium, Escherichia coli K-12. Mice were pretreated by a subcutaneous route with BPA (5 mg/kg body weight) for 5 consecutive days in the back and 3 days after the last treatment, injected by the intra-peritoneal route with E. coli K-12. BPA pretreatment caused a decrease of T and B cell populations in the spleen of treated mice. After the challenge with E. coli, the activity to eliminate bacteria from the peritoneal cavity in the early stage of infection (within 24 h) was diminished compared with non-treated mice. BPA induced the migration of excess neutrophils into the peritoneal cavity, but reduced their phagocytic activity against E. coli K-12. For macrophages and lymphocytes, BPA reduced the population in the spleen and the accumulation at infection foci. The production of MCP-1 was enhanced by BPA treatment, but that of IL-6 was suppressed after infection. These results suggest that BPA possessed immunotoxicity and reduced the non-specific host defense as an acute toxicity.     

Dermatomyositis and myelodysplastic syndrome with myelofibrosis responding to methotrexate therapy

Dermatomyositis (DM) has not yet been reported as a complication of myelodysplastic syndrome (MDS). A 50-year-old man was diagnosed as having MDS because of the presence of anemia, the appearance of immature cells in peripheral blood, and the abnormal cellular morphology. A few months later, high fever, myalgia and erythema developed. Although DM symptoms were resistant to high-dose corticosteroid administration, methotrexate (MTX) therapy improved not only the symptoms of DM but also hematologic findings related to MDS. This indicates that immunosuppressive therapy including MTX administration can be useful for patients with MDS with autoimmune symptoms.     

An easy and certain method to prevent dislodging of laparoscopic ports

The dislodgement of a laparoscopic port during surgery is a common problem in patients with thin abdominal walls, especially children. In this paper, we report a new technique and a simple device to fix a laparoscopic port. The device consists of an O-ring and connecting threads that are tied to the ring at two points. The connecting thread is passed though the port's cannula, and a trocar is set in the cannula beforehand. The port with the inner trocar is placed into the abdominal cavity, and the trocar is removed. The ring is brought into the abdominal cavity with a laparoscopic forceps through the cannula. After the tip of the forceps has been passed through the ring in the abdominal cavity, the thread connected to the ring is withdrawn, and the ring is fixed on the cannula by anchoring the thread on the port extracorporeally. Such a device was used to fix a total of 95 ports during 12 laparoscopic colectomies, 7 gastrectomies, 19 cholecystectomies, 2 appendectomies, and 1 resection of Meckel's diverticulum. Four children were among these cases. Not a single port slipped off, even in cases involving infants and obese patients. No complications relating to use of this device were observed. The new stabilizing device is simple, cost effective, and useful for prevention of the dislodging of various types of conventional ports, especially in the case of infants.     

Intraocular hemangiopericytoma. A case report

A 55-year-old man presented with a smoothly elevated solid choroidal mass with choroidal detachment in the temporal region of the left eye. Both fluorescein and indocyanine green angiography suggested a vascularized lesion such as an angioma. However, radiographic examination revealed a solid, circumscribed, dome-shaped mass. During a 3-month observation, the mass gradually enlarged and invaded the iris. The possibility of malignant melanoma could not be ruled out. Due to rapid and continued growth of the tumor, the eye was enucleated. Histopathologic examination revealed proliferation of spindle-shaped cells surrounding reticulin-positive vessels, which is characteristic of hemangiopericytoma. To our knowledge, this is only the fourth reported case of intraocular hemangiopericytoma and the first diagnosed in a male patient.