Surgery for pulmonary actinomycosis that was difficult to differentiate from lung cancer; report of a case

We herein report a case of pulmonary actinomycosis that was difficult to differentiate from lung cancer. The patient was a 53-year-old man who visited our hospital with a chief complaint of bloody sputum. Computed tomography (CT) showed a tumor in the anterior basal segment (S8) of the left lower lobe that contained a low density area, and because elevated C-reactive protein (CRP) was also observed, the patient was diagnosed with a lung abscess. As no improvements were seen after 4 months of antibiotic administration, and accumulation was observed at the same site on positron emission tomography (PET), the patient was diagnosed with lung cancer and underwent surgery. Following segmental resection, the patient was found to have pulmonary actinomycosis. It is necessary to consider pulmonary actinomycosis in patients with lung tumors.     

Recombinant sendai virus-mediated gene transfer to adipose tissue-derived stem cells (ASCs)

Adipose tissue-derived stem cells (ASCs) are expected to have clinical applications as well as other stem cells, because ASCs can be obtained safely from adult donors and used in autologous therapies without concern about rejection and the need for immunosuppression. However, the use of gene transfer with Sendai virus (SeV) vectors, which can efficiently introduce foreign genes without toxicity into several cells, with ASCs has not yet been investigated. This study documents on the use of SeV vectors for gene transfer to ASCs. The dose-dependent GFP expression of ASCs transfected with SeV vectors after 48 h of culture at 37 degrees C was first evaluated. Next, the cellular toxicity of ASCs transfected with SeV vectors was verified. In addition, SeV vectors were compared with adenovirus (AdV) vectors. Finally, the time-dependent GFP expression of ASCs transfected with SeV vectors was evaluated. The results showed that transfection of ASCs with SeV vectors results in more efficient expression of transgene (GFP expression) in the ASCs than with AdV vectors after 48 h of culture at 37 degrees C. Moreover, while the transfection of ASCs with AdV vectors at high MOIs was cytotoxic (a lot of transfected cells died) that of ASCs with SeV vectors at high MOIs was not necessarily cytotoxic. In addition, the preservation of multilineage ASCs transfected with SeV was observed. In conclusion, this is the first report describing the successful use of SeV-mediated gene transfer in ASCs, and the results indicate that SeV may thus provide advantages with respect to safety issues in gene therapy.     

Correlation between Hydroxyapatite Crystallite Orientation and Ultrasonic Wave Velocities in Bovine Cortical Bone

The mineral component of bone is mainly composed of calcium phosphate, constituting 70% of total bone mass almost entirely in the form of hydroxyapatite (HAp) crystals. HAp crystals have a hexagonal system and uniaxial elastic anisotropy. The objective of this study was to investigate the effect of HAp crystallite preference on macroscopic elasticity. Ultrasonic longitudinal wave velocity and the orientation of HAp crystallites in bovine cortical bone are discussed, considering microstructure, density, and bone mineral density (BMD). Eighty cube samples of cortical bone were made from two bovine femurs. The orientation of HAp crystallites was evaluated by integrated intensity ratio of (0002) peak using an X-ray diffractometer. Ultrasonic longitudinal wave velocity was investigated with a conventional pulse system. The intensity ratio of HAp crystallites and velocity were measured in three orthogonal directions; most HAp crystallites aligned in the axial direction of the femurs. Our results demonstrate a linear correlation between velocity and intensity ratio in the axial direction. Significant correlation between velocity and BMD values was observed; however, the correlation disappeared if we focused on the identical type of microstructure. In conclusion, differences in microstructure type have an impact on density and BMD, which clearly affects the velocity. In addition, at the nanoscopic level, HAp crystallites aligned in the axial direction also affected the velocity and anisotropy.     

Anterior dislocation of the subtalar joint: a case report

We report a very rare case of anterior dislocation of the subtalar joint. Forceful supination of the foot and dorsiflexion of the ankle was considered the cause of the injury in this case. Closed reduction was successful for the talocalcaneal component of subtalar joint, although surgery was subsequently performed because of the residual subluxation of the midtarsal joint including the talonavicular component of subtalar joint and the associated fracture of the lateral process of the talus. Satisfactory results were shown at three-year follow-up.     

Growth potential of orbital cavernous hemangioma suggested by vascular endothelial growth factor and its receptor flk-1

Orbital cavernous hemangiomas (CHs) manifest as slowly developing symptoms indicative of slow growth. The present study investigated the involvement of angiogenic factors and their receptors in the growth of orbital CHs. Surgical specimens of orbital CHs were obtained from nine patients. Formalin-fixed, paraffin-embedded specimens were stained immunohistochemically using antibodies against Ki-67, CD31, alpha-smooth muscle actin (alpha-SMA), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and VEGF receptors (flt-1 and flk-1). CD31 was expressed in the single layer of endothelial cells lining the vascular cavity. The thick vascular walls were positive for alpha-SMA, indicating that the vascular walls were smooth muscle cells. Ki-67 antigen immunostaining was mostly positive in the vascular walls and the staining index ranged from 0% to 6.8% (mean +/- standard deviation, 2.7 +/- 1.9%). VEGF and bFGF immunostaining were positive in all specimens. Flt-1 immunostaining was negative in all specimens, but flk-1 immunostaining was positive in both endothelial cells and smooth muscle cells. These results suggest that both VEGF and its receptor flk-1 are important in the growth of orbital CH.     

Informed consent for colorectal cancer surgery

There are two issues in informed consent for colorectal cancer surgery. One is the actual surgical technique. Recently intersphincteric resection (ISR) has been performed to avoid permanent colostomy, although it is not standard procedure. Regarding QOL score, Patients with colostomies do not necessarily have lower quality of life scores than patients who undergo sphincter-preserving surgery because of frequent bowel movements. Lateral lymphadenectomy for lower rectal cancer was standard procedure; however, its indications became limited due to urinary and sexual dysfunction. Preoperative radiotherapy is considered instead of lateral lymphadenectomy, as in the Western concept of the local recurrence of rectal cancer. Now laparoscopic surgery is accepted for stage I colon cancer according to the guidelines of the Japan Society for Cancer of the Colon and Rectum. The other issue is postoperative complications like anastomotic leakage, intestinal obstruction, etc. Frequent bowel movements and urinary and sexual dysfunction should also be explained before rectal cancer surgery.     

How to successfully resect 70 % of the liver in pigs to model an extended hepatectomy with an insufficient remnant or liver transplantation with a small-for-size graft

An insufficient remnant in extended hepatectomy and small-for-size graft in liver transplantation are critical matters in the field of liver surgery, and reliable and reproducible animal models that can provide clinically relevant and reliable data are needed. We herein describe our detailed surgical procedures for performing 70 % hepatectomy in pigs, and discuss the critical anatomical features, key techniques and pitfalls based on our experience. The porcine liver is divided into four lobes. The right lateral lobe (RLL) accounts for 30 % of the liver volume. Important points, such as selective temporal clamping of the arterial branch, confirmation of a related demarcation line, a two-step process to skeletonize Glisson’s capsules during liver resection and selective ligation of the portal venous branch to the right medial lobe without inducing any subtle injuries to Glisson’s capsules from the RLL to common bile duct, are discussed.     

Surgical treatment of liver injury with microwave tissue coagulation: an experimental study

OBJECTIVE: The purpose of this study was to examine whether microwave tissue coagulation (MTC) therapy is capable of stopping bleeding from severe liver injury in pigs. METHODS: Ten pigs (38 +/- 4 kg) underwent a 30-mL/kg isovolemic exchange transfusion with 3% low-molecular-weight dextran to produce dilutional coagulopathy, and then a through-and-through laceration injury measuring approximately 8 cm in length was induced in the right hepatic lobe. Immediately after inflicting the injury, the animals were randomly divided into two groups: Group A (n = 5, MTC was repeated along the liver laceration at intervals of 2.0 cm with manual compression) or Group B (n = 5, the injured lobe was manually compressed without MTC therapy for 1 minute). All animals received lactated Ringer's solution to maintain the mean arterial pressure at 75 mm Hg for 1 hour after the abdominal closure. The intraperitoneal blood loss, mean arterial pressure, volume of lactated Ringer's solution, and hematologic variables were compared between the groups. For further laboratory evaluation, three additional experimental animals were treated with the MTC therapy after inflicting the injury and then were allowed to survive for 14 days. RESULTS: Mean arterial pressure declined from a mean value of 88 +/- 10 mm Hg (range, 75-107 mm Hg) to 62 +/- 3 mm Hg (range, 50-75 mm Hg) after the induction of liver injury. The total blood loss in Group A was 192 +/- 58 g (range, 120-250 g), which was lower (p < 0.01) than that of 448 +/- 138 g (range, 260-650 g) in Group B. The resuscitation fluid volume of Group A animals was 304 +/- 204 mL (range, 100-600 mL), which was smaller (p < 0.01) than that of 1,320 +/- 654 mL (range, 900-2,250 mL) in Group B. At 14 days, all three animals that were treated in the additional study were found to be in good health. Their necropsies showed no evidence of an intrahepatic abscess, hematoma, or biloma. CONCLUSION: MTC therapy was thus found to provide simple, rapid, and definitive hemorrhage control in cases of severe liver injury without the need for reoperation.     

A case of superior mesenteric artery syndrome after left nephrectomy

Postoperative superior mesenteric artery syndrome is a rare complication of left nephrectomy. We treated a case of superior mesenteric artery syndrome that occurred 7 days after radical left nephrectomy for renal cell carcinoma. The patient was a 54-year-old Japanese man who presented with gross hematuria. Abdominal computed tomography showed a 3.8 x 3.8 x 5 cm heterogeneous cystic mass in the left kidney. Transperitoneal left radical nephrectomy was performed because renal cell carcinoma was suspected. The patient resumed oral intake 3 days after surgery, but he began vomiting repeatedly from the 7th day after surgery. Gastroduodenography showed an abrupt vertical linear obstruction of the third portion of the duodenum. Superior mesenteric artery syndrome was diagnosed. Conservative therapy (indwelling nasogastric tube, intravenous hyperalimentation and postural changes) was effective.     

Biomechanics in uniaxial compression of three distal radius volar plates

PURPOSE: A new fixed-angle volar plate for a dorsally displaced distal radius fracture was designed with the aim of avoiding soft tissue problems due to dorsal plating. The purpose of this study was to compare the biomechanical properties of this new plate with 2 existing volar plates in a cadaver model. METHODS: Three different plates were applied on surgically simulated unstable extra-articular distal radius fractures in formalin-fixed cadaver radiuses. Group 1 (volarly placed AO titanium Distal Radius plates [Synthes Ltd, Paoli, PA]; n = 6), group 2 (volarly placed titanium Symmetry plates [DePuy ACE Co, El Segundo, CA]; n = 6), and group 3 (volarly placed newly designed titanium plates; n = 6) were tested to failure under axial compression with a materials testing machine. Specimens of all 3 groups had similar bone mineral density. RESULTS: Group 3 specimens had significantly greater elastic limit and ultimate strength than the other 2 groups. Specimens of group 3 had the greatest rigidity, although this was statistically insignificant compared with the other 2 groups. All plates (groups 1, 2, 3) failed in apex volar angulation. CONCLUSIONS: The newly designed plate fixation system is the strongest of the systems tested and may offer adequate stability for the treatment of a distal radius fracture in which the dorsal and/or volar metaphyseal cortex is comminuted severely.