Treatment of persistent Mongolian spots with Q-switched alexandrite laser

Mongolian spots are congenital and confluent hyperpigmented areas that are usually grayish blue in color. They are found most frequently in the sacral region in infants and typically disappear during childhood. Occasionally, they persist to adulthood. We retrospectively examined outcomes of laser treatment of persistent Mongolian spots. We used Q-switched alexandrite laser to treat persistent Mongolian spots of 16 Japanese patients at 14?years old or older. A good therapeutic outcome was achieved overall; however, postinflammatory hyperpigmentation and hypopigmentation were observed in two patients, respectively. While laser treatment was effective for all seven patients with extrasacral Mongolian spots, four out of ten patients with sacral Mongolian spots were refractory to treatment. Of these patients, two received laser irradiation only twice and abandoned treatment, simply because of unsatisfactory results without any adverse events. The other two patients received treatments at intervals of 3?months, which resulted in postinflammatory hyperpigmentation. Contrary to children, who generally show good response after two or three sessions of irradiation, we should consider more frequent irradiation, longer intervals between treatment sessions, and use of bleaching creams in the treatment of persistent sacral Mongolian spots in adults.     

Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach-technical case report

The drainage of the superficial middle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV. We report a case in which modified surgical procedures via the ATPA were used to preserve the SBV. A 45-year-old man complained of right facial pain. Magnetic resonance images revealed a right cerebellopontine tumor suggestive of an epidermoid cyst. Right carotid angiography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. The convexity dura mater of the temporal lobe was cut and the anterior part of the temporal lobe was retracted subdurally. The SBV was visualized from the subdural side. The basal dura mater of the temporal lobe posterior to the SBV was cut and the posterior part of the temporal lobe was retracted epidurally. After dissecting the dura mater medial to the greater petrosal nerve and to the edge of the petrous apex, the petrous apex was exposed and drilled out without injuring the SBV. The superior petrous sinus and the tentorium were cut. The tumor compressed the root exit zone of the trigeminal nerve. The tumor was grossly totally removed. The modified ATPA (epidural anterior petrosectomy with subdural visualization of the SBV) is effective in preserving the SBV.     

Two phase imaging of<Superscript>99m</Superscript>Tc-SESTAMIBI and<Superscript>123</Superscript>I-BMIPP for patients with angina pectoris

We saw three cases of angina pectoris in which 99mTc-SESTAMIBI delayed images at rest were useful in diagnosing ischemia risk areas. These findings indicated that delayed 99mTc-SESTAMIBI images may be more sensitive to slight ischemia than 123I-BMIPP images, and suggested that imaging with 99mTc-SESTAMIBI twice at rest may be more effective. The addition of 123I-BMIPP SPECT was considered to be useful in making an evaluation of the severity of ischemia.     

The dose of radiotherapy in esophageal cancer combined with external beams and intracavitary radium brachytherapy

Between 1974 and 1982, 78 primary esophageal squamous cell carcinomas were treated by external irradiation combined with additional intracavitary radium therapy. 50 to 60 Gy were given by external irradiation, and 5 to 20 Gy were delivered on the surface of the esophageal mucosa. The combined dose ranged from TDF 110 to 140 on the esophageal mucosa and TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa. The 5-year survival rate was 19.3% by this combined radiotherapy alone. We conclude that the optimal dose of the combined therapy for esophageal cancer ranges from TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa.     

Acute tubulointerstitial nephritis associated with Yersinia pseudotuberculosis infection

Two siblings infected with Yersinia pseudotuberculosis suffered from acute renal failure about 2 weeks after the onset of the disease. Renal histology in both siblings showed acute tubulointerstitial nephritis. Yersinia pseudotuberculosis type VB was isolated from feces of one of them, antibodies to Yersinia pseudotuberculosis type VB in their sera were elevated. The results of the present study suggest that acute renal failure complicating infections with Yersinia pseudotuberculosis is due to acute tubulointerstitial nephritis.     

Increase of Integrin-Linked Kinase Activity in Cultured Podocytes upon Stimulation with Plasma from Patients with Recurrent FSGS

Recurrent focal segmental glomerulosclerosis (FSGS) is a major challenge in the field of transplantation. Integrin-linked kinase (ILK) has emerged as a key mediator of podocyte–glomerular basement membrane (GBM) interactions. To clarify the involvement of plasma factors in FSGS recurrence, we examined the effects of plasma from FSGS patients with or without posttransplant recurrence on cultured podocytes, focusing particularly on ILK activity. Podocytes from a conditionally immortalized mouse podocyte cell line were treated with plasma from 11 FSGS patients, and ILK activity was determined using an immune complex kinase assay. Treatment with plasma from three patients with recurrence induced an increase in ILK activity. In contrast, no increase in ILK activity was observed in cultured podocytes treated with plasma from the remaining three patients with recurrence and five patients without recurrence. Cultured podocytes treated with plasma that induced ILK activity showed alterations of focal contact and detachment from the laminin matrix. In conclusion, this preliminary study provides experimental evidence suggesting the possible presence of circulating toxic factors in the plasma of some patients with recurrent FSGS, which induce an increase in podocyte ILK activity that may lead to the detachment of podocytes from the GBM.     

Production and characterization of monoclonal antibodies to Fc gamma 2a-binding protein isolated from the detergent lysate of a murine macrophagelike cell line, P388D1

Hybridoma cell lines were produced by fusion of SP2/0 murine myeloma cell line with the spleen cells of Wister rats which were immunized with IgG2a-binding protein isolated from the detergent lysate of a murine macrophagelike cell line, P388D1, by affinity chromatography on IgG-Sepharose 4B. A monoclonal clone (designated as 3A2) out of a total of 13 different antibody-secreting cell lines was found to secrete IgG1 class antibodies, which inhibited more than 70% of the binding of radio-iodinated myeloma IgG2a protein to P388D1 cells. The 3A2 Fab fragments bound specifically to P388D1 cells at 4 degrees C with a KD of 1.9 x 10(-8) M and Bmax of 2.9 x 10(5) per cell. This Fab fragment also specifically bound to Fc gamma 2a receptor (R)-positive T cell line (S49) with a KD of 4.4 x 10(-9) M and a Bmax of 1.0 x 10(4) but did not bind to Fc gamma 2a-negative S49 variant cell line, cyc-. The flow cytometric analysis with the use of fluorescein-isothiocyanate-tagged 3A2 F(ab')2 also showed that this antibody binds to Fc gamma 2aR-positive cells, P388D1 and S49, but not to Fc gamma 2aR-negative cells, cyc-. Monomeric and heat-aggregated IgG2a (13-fold molar excess) inhibited the binding of the radioiodinated 3A2 F(ab')2 to P388D1 cells by 70 and 49%, respectively, whereas the inhibition by monomeric and heat-aggregated IgG2b was 17 and 39%, respectively; 3A2 F(ab')2 (100-fold molar excess) inhibited the binding of IgG2a and IgG2b to P388D1 cells by 90 and 24%, respectively, whereas the inhibition of binding of these IgG to S49 cells was 79 and 49%, respectively. Western blotting analysis showed that 3A2 antibody recognizes a major protein (Mr = 100,000) and a minor component (Mr = 80,000) separated by SDS-PAGE of P388D1 or S49 cell lysates under nonreducing condition, whereas under reducing condition, this antibody recognized a major protein (Mr = 50,000) and two additional minor components (Mr = 40,000 and 35,000). Fc gamma 2aR may thus exist at the cell surface as a disulfide linked dimer of a subunit of Mr of 50,000, which could be partially degraded during the isolation to smaller fragments of 40,000 and 35,000 Mr peptides which are still held together by interchain disulfide bond.(ABSTRACT TRUNCATED AT 250 WORDS)