A case of congenital midline cervical cleft with congenital heart disease

A congenital midline cervical cleft (CMCC) is a rare developmental anomaly. It may represent failure of the branchial arches to fuse in the midline and presents at birth with a ventral midline defect of the skin of the neck. Congenital heart disease along with CMCC is rarer, and most of the cases reported are associated with chest wall defects or thoracic ectopia cordis. The authors report a case of a 5-month-old girl with CMCC and an atrial septal defect (ASD) and discuss the clinical presentation, embryologic development, and treatment.     

Functional disorders of the oxidative phosphorylation system in the heart mitochondria of mice with juvenile visceral steatosis

Mice with juvenile visceral steatosis (JVS) develop remarkable cardiac hypertrophy and exhibit an increased number of mitochondria in their heart. However, the biochemical characteristics and physiological functions of these mitochondria cardiac are little known. Here we show that the respiratory activities at state 3 with glutamate plus malate or succinate in the heart mitochondria of JVS mice were greatly decreased to 47% or 77%, respectively, compared with those of control mice. The contents of cytochromes a+a(3), b, and c+c(1) in the heart mitochondria of these mice were also decreased, to 51%, 45%, and 79%, respectively, of those of the control mice. Oligomycin-sensitive ATPase activitiy in these mitochondria, however, was increased to about 2 times over that of the control mice. Surprisingly, the ATP-Pi exchange activity of the heart mitochondria of JVS mice was greatly decreased, to 35% of that of control mice. On the other hand, the expression levels of 2 subunits of H(+)-ATP synthase, i.e., coupling factor 6 and alpha subunit, in heart mitochondria from control and JVS mice were almost the same. These results indicate that the coordinate regulation of mitochondrial proliferation and gene expression for components of the oxidative phosphorylation system was markedly defective in the heart of JVS mice. Our current results also suggest the presence of a novel regulatory mechanisms of ATP synthase activities in the heart.     

Advances in brachytherapy--focusing on the permanent implant for early prostate carcinoma

Even in the modern era of advanced external radiotherapy, brachytherapy is an important and useful modality of radiotherapy. In North America and Europe, it has been noted that the proportion of prostate cancer patients treated by HDR or LDR interstitial brachytherapy is rapidly increasing, as it offers several practical and theoretical advantages over external radiotherapy. HDR treatment with 192Ir remote afterloader provides an optimized dose distribution controlled by an accurate dwell time and position of 192Ir source. LDR brachytherapy is a simple, minimally invasive, and outpatient based procedure that avoids hospitalization and allows the patient an early recovery and rapid return to normal activities. It has produced good 10-year outcome with relatively low morbidity. Although in Japan this treatment was behind North America and Europe, the 125I-seed source was approved by the Japanese FDA and a rule for patient discharge was developed recently. The first case was treated in September 2003 and this treatment is expected to become an important option for early prostate cancer. Several areas of brachytherapy including treatment planning, choice of radionuclide, treatment procedure, and treatment outcome are discussed in this paper.     

Secretory Carcinoma of the Breast with a Cystically Dilated Intraductal Component: Report of a Case

A case of secretory carcinoma of the breast in a 61-year-old woman is described. She came to our hospital complaining of a bloody nipple discharge. The physical examination revealed a 2.8 × 2.1-cm, firm, irregular lump with bloody nipple discharge in her left breast. Mammography demonstrated an irregular mass and ultrasonography showed an irregular hypoechoic mass accompanied with a cyst. Ductgraphy was done. It showed a dilated mammary duct leading to the cyst which was partially occupied with carcinoma. A cytologic smear of the nipple discharge and fine-needle aspiration cytology revealed similar findings, and both findings were malignant. A modified radical mastectomy was performed. A pathological examination revealed secretory carcinoma of the breast which had spread inward and outward from the cyst. In addition, the nipple discharge flowed from the cyst through the dilated mammary duct. The patient is presently alive and well 2 years after the operation. Secretory carcinoma is an extremely rare tumor of the breast and 48 cases have been reported in Japan. The present case is the first known case of secretory carcinoma demonstrating a bloody nipple discharge to come from a cyst which has been invaded by carcinoma. Received: December 7, 2000 / Accepted: January 8, 2002 Reprint requests to: J. Izumi, Department of Surgery, Kyouritsu Hospital, 16-5 Chuoh-cho, Kawanishi 666-0016, Japan     

Patulous eustachian tube following otitis media

Loss of weight, dehydration, pregnancy, fatigue, and otitis media are among the factors proposed as causes of a patulous eustachian tube, but true details remain obscure. We studied patients who developed a patulous eustachian tube following otitis media and discuss the relationship between these 2 conditions. Subjects were 12 patients diagnosed with otitis media at our department who later developed a patulous eustachian tube. The initial middle ear disease progressed from acute otitis media to otitis media with effusion in 2, acute otitis media in or acute mastoiditis in 1 each, and otitis media with effusion in the remaining 8 patients. Seven patients evidenced a low body mass index (BMI), weight loss, and underlying disease, but 5 with a patulous eustachian tube following otitis media did not. We retrospectively analyzed 119 patients diagnosed with a patulous eustachian tube in our department for whether they had been diagnosed by an ENT physician as having otitis media, i.e., acute otitis media or otitis media with effusion. Some 42 (35.3%) had a history of otitis media. At acute otitis media or otitis media with effusion, the tympanic cavity becomes inflamed, accompanied by inflammation of the eustachian tube mucosa and a stenotic tendency. Healing from otitis media is accompanied by decreased eustachian tube mucosa inflammation. We surmise that, depending on how inflammation disappears, fibrosis of the eustachian tube mucosa occurs, leading to a pathologically patulous eustachian tube. Many aspects of the causation of this condition remain unclear, but we surmised that in patients with earlier otitis media, a pathological patulous eustachian tube develops during resolution of inflammation. Our findings indicate the involvement of otitis media as a causative factors in a patulous eustacian tube.     

Prevalence of Salmonella and E. coli,and their resistance to antimicrobial agents,in farming communities in northern Thailand

A cross-sectional pilot study was conducted in Chiang Mai, Thailand, to determine the prevalence of Salmonella and Escherichia coli in swine, broiler chickens and human workers from farms and abattoirs in northern Thailand, and compare their antimicrobial resistance profiles. Fecal samples and cloacal swabs were collected from 150 swine and 150 chickens at the farm. Fecal samples from swine, cloacal swabs from chickens, and carcass swabs from both animals were collected from 100 swine and 100 chickens at the abattoir. Stool samples were collected from 15 swine farm workers and seven chicken farm workers. Primary isolation and identification of Salmonella and E. coli were conducted using standard methods. In vitro susceptibility testing of Salmonella and E. coli was conducted using the broth microdilution method, based on the United States National Committee for Clinical Laboratory Standards (NCCLS) guidelines. The prevalence of Salmonella from swine and chicken samples ranged from 2% to 25%. The prevalence of E. coli in chickens and swine ranged from 36.8% to 47.6%. In humans, the prevalence of Salmonella was 15%, and the prevalence of E. coli ranged from 51% to 53%. Resistance in Salmonella was found for tetracycline (84.7%), nalidixic acid (27.1%), florfenicol (18.6%), ampicillin (13.6%), and ceftiofur (3.4%), and in E. coli for tetracycline (91.5%), nalidixic acid (67.4%), ampicillin (61.6%), florfenicol (51.8%), enrofloxacin (28.7%), ciprofloxacin (12.5%), ceftiofur (4.9%) and ceftriaxone (1.5%).     

Primary liver cancers with nonalcoholic steatohepatitis

Nine patients with hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) (six men and three women, median age 71.5 years) and one patient with intrahepatic cholangiocarcinoma (ICC), a 50-year-old man, in NASH are described. Most patients were associated with obesity, diabetes, hypertension, hypercholesterolemia, or hypertriglyceridemia. Seven patients showed insulin resistance and hyperinsulinemia. All patients except one met the criteria for metabolic syndrome. An HCC or ICC diagnosis was confirmed by tumor biopsy, surgery or autopsy except in two patients, who were diagnosed by computed tomography or hepatic angiography. The underlying liver disease was liver cirrhosis in six patients and chronic liver disease including mild hepatic fibrosis in four patients. The treatment of liver cancers consisted of surgery, radio-frequency ablation (RFA), transcatheter arterial embolization and transcatheter arterial infusion. Although the follow-up period was relatively short (median 27.5 months, average 32.1 months), all postoperative and post-RFA patients have not had a recurrence of HCC to date, except for one patient who had a palliative operation with intra-arterial infusion of anticancer drugs through an implanted reservoir port. Older age and liver cirrhosis are considered risk factors for HCC in NASH, and regular screening of these patients is necessary. Diabetes may contribute to the development of ICC in NASH. Curative therapy (surgery or RFA) and weight loss by the active therapeutic intervention (nutritional care and exercise therapy) after curative therapy may help us improve the prognosis of HCC in NASH.