Novel strategy for soft tissue augmentation based on transplantation of fragmented omentum and preadipocytes

Current therapeutic procedures for soft tissue augmentation still lack the ability to induce rapidly formation of adipose tissue and its long-term stability, which is determined by rapid revascularization. The omentum is highly vascularized with microvascular endothelial cells (ECs) and is composed mainly of adipocytes that produce an enormously high level of vascular endothelial growth factor (VEGF). The aim of this study was to determine the potential usefulness of fragmented omentum tissues, with or without cotransplantation with preadipocytes, in soft tissue augmentation. Fragmented omentum tissues (approximately 500 mg) with or without preadipocytes (approximately 2.3 x 10(6)) isolated from epididymal adipose tissues were transplanted under the dorsal skin of Wistar rats by percutaneous injection and the tissues were left under the skin for up to 12 weeks. Regardless of cotransplantation with preadipocytes, the general morphological features of the transplanted tissue were as follows. The transplanted tissues, the weight loss of which was limited to 30-40%, contained viable adipocytes and some pseudocysts surrounded by fibrotic septa with minor inflammatory cell infiltration. High levels of triacylglycerol content, capillary density, and VEGF production were observed in transplanted tissues 12 weeks postoperation. Cotransplantation with preadipocytes enhanced adipose tissue formation significantly. These observations strongly indicate that transplantation of fragmented omentum tissues or cotransplantation with preadipocytes may be a promising therapeutic procedure for soft tissue augmentation.     

Association of Schatzki ring with eosinophilic esophagitis in children

OBJECTIVE: To describe the clinicopathologic characteristics of children with Schatzki ring and to determine if Schatzki ring is associated with eosinophilic esophagitis. METHODS: The authors report 18 adolescents with radiographically diagnosed Schatzki ring (SR). Their clinical and histologic characteristics were reviewed in a blinded fashion. RESULTS: The mean age of the patients was 15.8 +/- 0.8 years and mean duration of symptoms was 2.6 +/- 0.4 years. By histologic criteria, two groups of patients were defined. Eight had clinical and histologic criteria of eosinophilic esophagitis (EE) and 10 of peptic esophagitis. There were no differences in the symptoms or radiographic findings in the two groups. The SR was not identified by endoscopy in any EE patient and was identified in 70% of peptic esophagitis patients. Grossly apparent mucosal features associated with EE were significantly more common in those with EE. Those with peptic esophagitis had a significantly higher acid exposure than did those with EE (12.6 +/- 2.9 v 2.0 +/- 1.1%; P < 0.01) by esophageal pH probe. Patients with peptic esophagitis responded to proton pump inhibitors and/or dilatation, whereas those with EE did not have good response and required specific therapy for EE. CONCLUSIONS: EE may play a role in the pathogenesis of some patients with SR.     

Clinical study on papillary thyroid carcinoma presenting with lymph node metastasi

Papillary thyroid carcinoma (PTC) may metastasize to cervical lymph nodes. It is, however, uncommon for a palpable neck node alone to lead to the diagnosis of this disease when it is not apparent at presentation. Standard treatment for such cases has not yet been established. We retrospectively analyzed clinical courses in 8 patients with thyroid papillary carcinoma presenting with palpable lymph node metastasis at Hokkaido University Hospital between 1990 and 2003. Three had high thyrogloblin in cervical cystic lesions, leading to the diagnosis of PTC with lymph node metastasis. In 4, PTC was diagnosed by pathological examination of cervical lymph nodes initially diagnosed as lateral cervical cysts. Preoperative examination did not indicate PTC within the gland in any case. All 8 were alive at the last visit after follow-up from 23 to 150 months (mean: 78 months). Total thyroidectomy was done on 4 and thyroid lobectomy on 3. Pathological examination of resected thyroid glands confirmed multifocal papillary carcinoma from 4 mm to 15 mm in diameter. Six underwent unilateral neck dissection and 1 chose bilateral dissection. The other patient received no additional surgery on either the thyroid or neck after the single enlarged lymph node initially diagnosed as a lateral cervical cyst was resected. Postoperative radioiodine treatment was done in 2 undergoing total thyroidectomy. Recurrence in the cervical area were observed in 1 whose neck dissection was insufficient. Based on these observations, we concluded that patients who undergo thyroid lobectomy and adequate neck dissection may enjoy longer survival than those treated with total thyroidectomy without sacrificing thyroid and parathyroid function. We therefore propose a prospective study on the effectiveness of thyroid lobectomy with neck dissection including positive nodes in patients with occult PTC presenting with lymph node metastasis.     

Combined proteomic approach with SELDI-TOF-MS and peptide mass fingerprinting identified the rapid increase of monomeric transthyretin in rat cerebrospinal fluid after transient focal cerebral ischemia

Several proteins are known to be markedly expressed in the brain during cerebral ischemia, however the change in protein profiles within the cerebrospinal fluid (CSF) after an ischemic insult has not been fully elucidated. We studied the changes in the CSF proteome in rat transient middle cerebral artery occlusion model. Surface enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) was used to detect the time-course changes in CSF protein patterns after transient focal brain ischemia. According to hierarchical cluster analysis by self-organising tree algorism (SOTA), the temporal pattern of protein peaks was divided into four groups: acute increase group, chronic increase group, gradual decrease group and unchanged group. In the acute increase group, the expression of a 13.6-kDa protein was markedly increased during the acute phase. The 13.6-kDa protein was identified as monomeric form of transthyretin using two-dimensional electrophoresis and peptide mass fingerprinting based on matrix-assisted laser desorption/ionization-time of flight mass spectrometry. The monomeric transthyretin may represent an ischemia-specific CSF marker to indicate the sequential changes according to ischemic insults of the brain.     

Evaluation of tumor development from the viewpoint of the three-dimensional configuration of isolated crypts in colorectal adenomas with a type III<Emphasis Type="SmallCaps">l</Emphasis> pit pattern

Background The relationship between the three-dimensional configurations of superficial and protruded-type colon tumors with a type IIIl pit pattern was examined to evaluate their morphological development.Methods Forty-five isolated crypts of superficial-type adenomas and 65 isolated crypts of protruded-type adenomas were evaluated, all derived from segments of 12 colorectal lesions removed by surgery or endoscopic resection. For isolation of the crypts, an HCl-digestion method was used. Morphological features of the isolated crypts were observed by scanning electron microscopy (SEM). We investigated the configuration, length, and width of the isolated crypts in a comparison of the superficial and protruded-type tumors. The configuration and surface structure of the crypts were classified into three types (scores 1 to 3) by the shape and degree of branching and protuberances on their surface.Results The average lengths of the isolated crypts of the superficial and protruded types were 310.9 ± 122.9µm (n = 45) and 434.4 ± 163.3µm (n = 65), respectively (P < 0.001), and the average widths of the superficial and protruded types were 140.4 ± 68.2µm and 171.5 ± 73.3µm, respectively (P = 0.02). The average scores for the degree of branching and protruberances in the superficial and protruded types were 1.178 ± 0.442 and 1.569 ± 0.529, respectively (P < 0.0001). In terms of configuration, in the isolated crypts, the superficial-type tumors exhibited a two-layer structure and the protruded type had the shape of a spindle with protuberances.Conclusions In colorectal tumors with a type IIIl pit pattern, the isolated crypts of protruded-type tumors displayed more roughness on their surface structure and were longer than those of superficial-type tumors. This suggested that the three-dimensional configuration of the isolated crypt constitutes an important factor in the formation of the gross configuration of colorectal tumors. Colorectal superficial and protruded-type tumors may develop with different growth patterns.     

Transanal Laser Doppler Flowmetry to Assess Microcirculation in the Upper Rectum During Abdominal Aortic Aneurysmectomy

Purpose. Fatal ischemic colitis can develop after abdominal aortic aneurysmectomy. We investigated the effectiveness of transanal laser Doppler flowmetry (LDF) for assessing microcirculation in the rectal mucosa during aneurysm repair. Methods. The subjects were 17 patients who underwent abdominal aortic aneurysmectomy. A Doppler laser and Doppler probe were mounted on a rectoscope, which was inserted into the anus, and rectal flux values were obtained by a flowmeter. Results. The mean flux value during aortic clamping was 146 ± 35.6 perfusion units (PU) in patients with sufficient collateral circulation to the upper rectum and 58.3 ± 19.4PU in patients with insufficient collateral circulation (P 0.01). The LDF values and inferior mesenteric artery stump pressure measurements were well correlated (r = 0.86). Conclusion. Transanal rectal LDF is useful for continuously assessing microcirculation in the rectal mucosa during abdominal aneurysmectomy, and the data obtained with this method may reflect whether a collateral pathway to the upper rectum exists.     

Neuropathological features of a case with schizophrenia and prion protein gene P102L mutation before onset of Gerstmann-Sträussler-Scheinker disease

Gerstmann-Sträussler-Scheinker disease (GSS) is a hereditary transmissible spongiform encephalopathy associated with prion protein gene mutation P102L. The age of onset is roughly restricted to around the sixth decade; however, it is unclear whether the disease-specific pathology of GSS is already evident in the pre-clinical stage. We had a chance to examine an autopsy case with PRNP P102L mutation. The patient had died at 50 years of age before the clinical symptoms of GSS had appeared; neither neuronal loss, gliosis nor spongiform change was found anywhere in the brain. Immunohistochemistry failed to detect any deposition of prion protein. It is thus considered that amyloid plaque formation in GSS probably develops in a relatively rapid fashion compared with Alzheimer's disease. Although the patient suffered from schizophrenia, no significant pathological changes were detected except for astrocytic inclusion bodies in the cerebral cortex. The nature and significance of the inclusion bodies, which are not observed in patients with GSS, remain unclear.