Hyperostosis around the bilateral acetabulum associated with hypoparathyroidism

We report the case of a 57-year-old woman with hyperostosis around the bilateral acetabulum associated with untreated secondary hypoparathyroidism. She presented with gait disturbance and inability to walk. Radiographs showed abnormal ossification around her hips. We resected the ossifications to improve joint function. One year after surgery, radiographs showed no recurrence of ossification. When radiographs show excessive hyperostosis, it is important to exclude presence of metabolic bone disease.     

Extraperitoneal colostomy in laparoscopic abdominoperineal resection using a laparoscopic retractor

Although extraperitoneal colostomy is often performed to prevent postoperative parastomal hernia formation following an open abdominoperineal resection of lower rectal cancer, it has not been widely employed laparoscopically because of the difficulty associated with the extraperitoneal route. This paper describes a laparoscopic extraperitoneal sigmoid colostomy using the Endo Retract? Maxi instrument. This surgical technique is easy, and helps to prevent the development of parastomal hernias.     

Using intraoperative radiography to detect incomplete seating of Trident acetabular system ceramic liners

Purpose

There have been some reports of incomplete seating of the ceramic liner in the Stryker Trident acetabular system. We sought to prevent incomplete seating through the use of intraoperative radiography.

Method

We retrospectively reviewed 21 hips in 18 patients who had undergone total hip arthroplasty using a posterolateral approach with a Stryker Trident ceramic liner. All procedures included an intraoperative anteroposterior view radiograph to evaluate liner seating. If incomplete seating was recognized we reinserted the liner. We investigated whether this technique made it possible to detect and correct incomplete seating.

Results

Six of the 21 hips evidenced incomplete seating. In four of these hips, the incomplete seating was revealed on the intraoperative radiograph: two were reinserted properly, one was replaced with a polyethylene liner, and in the last one the incomplete seating was missed despite the radiographical evidence. The location of the gap between the socket and liner caused by the incomplete seating was inferior in all these cases. Intraoperative radiography did not indicate incomplete seating in two hips in which the location of the gap was anterior; the problem was revealed by postoperative lateral view radiography.

Conclusion

With a posterolateral approach in a lateral decubitus position, the use of intraoperative radiography was effective when the gaps were superior or inferior. However, this approach made it easy to miss anterior gaps and intraoperative radiography did not reveal them.     

Antibody‐mediated rejection after ABO‐incompatible pediatric living donor liver transplantation for propionic acidemia: A case report

We herein present the case of a four‐yr‐old boy with PA who developed AMR after ABO‐incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO‐incompatible LDLT 36 days after the administration of rituximab. The CD19+ lymphocyte count just prior to LDLT was 1.2%. He developed AMR five days after LDLT, and the antidonor‐type IgM and IgG antibody titers increased to 1:1024 and 1:1024, respectively. He was treated by plasma exchange, IVIG, steroid pulse therapy, and rituximab re‐administration; however, his liver dysfunction continued. Despite intensive treatment, he died due to complicated abdominal hernia, acute renal failure, and ARDS. This case suggests that a streptococcal infection may induce the activation of innate immune responses; thus, additional desensitization therapy should be considered prior to ABO‐incompatible LDLT if B cell reactivation is suspected.     

Chronic Hyponatremia Causes Neurologic and Psychologic Impairments

Hyponatremia is the most common clinical electrolyte disorder. Once thought to be asymptomatic in response to adaptation by the brain, recent evidence suggests that chronic hyponatremia may be linked to attention deficits, gait disturbances, risk of falls, and cognitive impairments. Such neurologic defects are associated with a reduction in quality of life and may be a significant cause of mortality. However, because underlying diseases such as adrenal insufficiency, heart failure, liver cirrhosis, and cancer may also affect brain function, the contribution of hyponatremia alone to neurologic manifestations and the underlying mechanisms remain unclear. Using a syndrome of inappropriate secretion of antidiuretic hormone rat model, we show here that sustained reduction of serum sodium ion concentration induced gait disturbances; facilitated the extinction of a contextual fear memory; caused cognitive impairment in a novel object recognition test; and impaired long-term potentiation at hippocampal CA3–CA1 synapses. In vivo microdialysis revealed an elevated extracellular glutamate concentration in the hippocampus of chronically hyponatremic rats. A sustained low extracellular sodium ion concentration also decreased glutamate uptake by primary astrocyte cultures, suggesting an underlying mechanism of impaired long-term potentiation. Furthermore, gait and memory performances of corrected hyponatremic rats were equivalent to those of control rats. Thus, these results suggest chronic hyponatremia in humans may cause gait disturbance and cognitive impairment, but these abnormalities are reversible and careful correction of this condition may improve quality of life and reduce mortality.     

In vitro and in silico characterisation of Lactobacillus paraplantarum D2-1, a starter culture for soymilk fermentation

Soymilk contains several functional nutrients and is thus a promising ingredient for production of functional foods. The present research aimed to study starter properties, functional characteristics and safety of Lactobacillus paraplantarum D2-1, a promising starter culture for soymilk fermentation. Strain D2-1 actively fermented soymilk within 24?h but had weak activity of additional acid production after 7 d. Succinate and acetoin, which could be linked to flavour and taste, were accumulated in fermented soymilk. In vitro study revealed that the organism has several beneficial properties, including high survival ability in artificial gastric juice, high abilities of mucus adhesion and biofilm formation and production of γ-aminobutyric acid and conjugated linoleic acid, without any significant risks for consumption. Genome sequencing supported the desirable metabolic properties of the strain. These results indicate that L. paraplantarum D2-1 is a suitable starter for soymilk fermentation and is a promising probiotic candidate that can be used safely.