New hepatic vein reconstruction in left liver graft.

The incidence of hepatic venous stenosis is higher in partial liver transplantation. New methods for hepatic venous reconstruction in left liver transplantation, which secure wide anastomosis, were devised and are reported here. In the graft, the right side of the middle hepatic vein or the left side of the left hepatic vein was cut longitudinally and a rectangular-shaped vein patch was attached for venoplasty. In the recipient, after the left and middle hepatic veins were joined, the right side of the middle hepatic vein was cut toward the closed right hepatic vein, making a horizontal cavotomy for anastomosis. Of 92 patients who underwent conventional hepatic vein reconstruction, 3 were complicated by hepatic venous stenosis (median follow-up 43 months). By contrast, there were no hepatic vein complications in the 20 patients who underwent the new technique (7 months). The current method appears to be technically feasible for outflow reconstruction in left liver graft transplantation.     

Congenital absence of a lumbar pedicle presenting with contralateral lumbar radiculopathy

The authors describe a rare case of a congenital absence of the right L5 pedicle in a 54-year-old man presenting with low back pain and radicular pain of his left leg. Plain x-ray films, computed tomography scan (CT) after myelography, and three-dimensional CT revealed the absence of the L5 pedicle and anomaly of the L4-L5 facet joint on his right side. On the left side, there were severe degenerative changes that were thought to be the result of an overload and instability. The degenerative changes led to late-onset neurologic impairment of the contralateral side, which was treated with spinal fusion. To our knowledge, this is the first report of contralateral symptoms due to unilateral defect of the facet joint accompanied by aplasia of a pedicle.     

Local intraarterial fibrinolysis in central retinal artery occlusion: case report

The authors report a case of local intraarterial fibrinolysis (LIF) in central retinal artery occlusion (CRAO). A 79-year-old man with stenosis of the left internal carotid artery (ICA) suffered sudden loss of vision in his left eye. LIF was carried out using a microcatheter in the origin of the ophthalmic artery on the side of the CRAO. Treatment was performed with 120,000 IU of urokinase. After LIF, marked improvement of vision was established. No complication occurred during LIF. One month later, carotid artery stenting was performed for the left ICA stenosis. We consider LIF in CRAO is effective treatment.     

Optical coherence tomography images of spontaneous macular hole closure

PURPOSE: To investigate optical coherence tomography images of spontaneous macular hole closure. METHOD: Case report. In a 60-year-old woman with full-thickness macular hole, posterior vitreous detachment, and previous branch retinal vein occlusion, we observed the entire course of spontaneous macular hole closure by use of optical coherence tomography. RESULTS: Spontaneous macular hole closure began as the inward protrusion of the tissue around the margin of the macular hole. The protruding tissue then connected to bridge the macular hole, which mimicked a foveal retinal detachment. The bridged tissue gradually thickened, and the foveal detachment and perifoveal cysts resolved. The fovea eventually regained its normal configuration. CONCLUSIONS: The bridging of the protruding retinal tissue over the macular hole plays a key role in spontaneous macular hole closure.     

Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy

PURPOSE: To identify the tomographic features of the branching vascular networks in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We prospectively performed third-generation optical coherence tomography (OCT) and fluorescein angiography for 44 eyes of 42 patients (mean age +/- SD, 67.1 +/- 9.1 years) with PCV. All eyes had branching vascular networks and polypoidal lesions that were confirmed by indocyanine green angiography. RESULTS: OCT showed double reflective layers that consisted of retinal pigment epithelium (RPE) and another highly reflective layer beneath the RPE ("double-layer sign") in the area of the branching network vessels in 26 (59%) of 44 eyes. The remaining 18 eyes had no double-layer sign, but 17 (94%) of 18 eyes had a slightly elevated RPE. A serous retinal detachment was present in 23 (88%) of 26 eyes with a double-layer sign, while only 1 (6%) of 18 eyes without the sign had a serous retinal detachment. CONCLUSIONS: In PCV, the double-layer sign is seen frequently in the area of the network vessels, particularly in eyes with a serous retinal detachment. The sign may reflect fluid accumulation between RPE and Bruch membrane resulting from leakage from the network of abnormal vessels.     

Acute exanthematous pustular drug eruption induced by mexiletine

A 56-year-old man developed infiltrated erythemas on the trunk, extremities, and face with marked facial edema, one month after taking mexiletine hydrochloride for his arrhythmia. A number of pustules were also noted on the surface of erythemas on his chest and face. Laboratory examination showed liver dysfunction and hypereosinophilia. The culture from pustules was sterile. Histological examination of the biopsied skin from a pustular lesion revealed a subcorneal abscess, and perivascular infiltration of lymphocytes, mononuclear cells and eosinophils in the upper dermis. The skin lesions and facial edema as well were improved within three weeks by withdrawal of mexiletine hydrochloride. Patch tests with 10% and 20% mexiletine hydrochloride in petrolatum showed positive reaction, however, pustules were not provoked on the tested site. We conclude that pustules, infiltrated erythema and facial edema were the signs of acute exanthematous pustular drug eruption induced by mexiletine hydrochloride.     

Identification of CD8alpha+CD11c- lineage phenotype-negative cells in the spleen as committed precursor of CD8alpha+ dendritic cells

CD8alpha+ dendritic cells (DCs) represent a functionally distinct DC subset in vivo, which plays a critical role in initiating various cellular immune responses. However, the committed precursor of CD8alpha+ DCs remains to be identified. We reported here that murine splenic CD8alpha+CD11c- lineage phenotype (Lin)- cells could differentiate into CD8alpha+ DCs in vivo after intravenous transplantation. Immunohistochemistry staining showed that donor-derived DCs mainly located in T-cell areas of the spleen. Functionally, these CD8alpha+CD11c-Lin- cell-derived DCs were capable of stimulating allogenic T-cell response, as well as secreting bioactive interleukin 12 p70 and interferon gamma. Freshly isolated CD8alpha+CD11c-Lin- cells expressed CC chemokine receptor (CCR)2, CCR5, and CCR7 messenger RNA, whereas CD8alpha+ DCs derived from CD8alpha+CD11c-Lin- cells further obtained the expression of CCR6 and macrophage-derived chemokine. Flow cytometry analysis showed that CD8alpha+CD11c-Lin- cells were identified in bone marrow and lymph nodes. Moreover, transplanted splenic CD8alpha+CD11c-Lin- cells could also home to thymus and lymph nodes and were capable of developing into CD8alpha+ DCs in these locations. However, CD8alpha+CD11c-Li- cells failed to differentiate into CD8alpha- DCs, T cells, natural killer cells, or other myeloid lineage cells in irradiated chimeras. Taken together, all these findings suggest that CD8alpha+CD11c-Lin- cells are a committed precursor of CD8alpha+ DCs.     

Early colon cancers detected by FDG-pet: a report of two cases with immunohistochemical investigation

Increased glucose uptake is one of the metabolic characteristics of tumor cells. 18F-fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET), a technique that is used widely to study this altered glucose metabolism in tumors, allows the detection of various types of malignancy. We present herein two cases of early colon cancers detected incidentally by FDG-PET. The technique was used as part of the screening examinations for preoperative staging, and for postoperative follow-up. In both cases, the lesions were removed by colonoscopic polypectomy, with no complications. Moreover, we confirmed the existence of altered glucose metabolism in the resected specimen by immunohistochemical staining using an antibody raised against Glut1. Immunohistochemically, Glut1 was expressed in vitro in both of the lesions, supporting the positive FDG-PET result obtained in vivo. To our knowledge, this is the first report to describe in vitro Glut1 expression and in vivo tumor detection using FDG-PET in colorectal carcinoma.