Different subtype distributions in two cities in Myanmar: evidence for independent clusters of HIV-1 transmission

A molecular epidemiological investigation was conducted in two major cities in Myanmar (Yangon and Mandalay). The study revealed a unique predominance of HIV-1 subtype B' (Thailand variant of subtype B) among injecting drug users in Yangon, indicating the strong founder effect of this variant. In contrast, multiple lineages of HIV-1 strains were found in Mandalay, leading to the evolution of various forms of intersubtype recombinants. The results showed independent clusters of HIV-1 transmission in Myanmar.     

Perforation of the descending aorta by the tip of an intra-aortic balloon pump catheter.

Perforation of the proximal descending aorta occurred in a patient on intra-aortic balloon pump (IABP) support after emergency coronary intervention for acute myocardial infarction. The IABP catheter was inserted under fluoroscopic guidance into the right femoral artery without difficulty, but after 8 h on IABP support the patient went into shock with a left hemothorax. Emergency surgery was performed with cardiopulmonary bypass and a perforation of the proximal descending aorta with active bleeding was found and successfully repaired. A distorted descending aorta in which the IABP catheter was kinked, as in the aortic arch, was discovered during surgery and confirmed postoperatively with 3-dimensional computed tomography scans, particularly in the lateral view. Not only the antero-posterior but also the lateral fluoroscopic view is recommended to prevent aortic perforation by a kinked IABP catheter.     

A case of true pulmonary carcinosarcoma]

A 72-year-old male was admitted to our hospital because of dyspnea. A chest radiograph showed a mass shadow measuring 40 x 40 mm in the left lower lobe, and fiberoptic bronchoscopy revealed obstruction of the left B8 by the tumor. Adenocarcinoma was suspected after a transbronchial biopsy, and left lower lobectomy was performed. Histologically, the resected specimen was composed of carcinomatous and sarcomatous elements, and further immunohistological study revealed that the former component was poorly differentiated squamous cell carcinoma and the latter was fibrosarcoma. We therefore concluded that the tumor was a true carcinosarcoma of the lung.     

Attenuation of biventricular pressure gradients by cibenzo-line in an 18-year-old patient with hypertrophic obstructive cardiomyopathy.

An 18-year-old male patient with biventricular hypertrophic obstructive cardiomyopathy (HOCM) had successful reduction of the pressure gradients by cibenzoline. At 11 months after birth, he was first diagnosed with cardiac murmurs and by the age of 5 years, he was diagnosed with subpulmonic infundibular stenosis with a pressure gradient of 10 mmHg by cardiac catheterization. At the age of 14, re-catherterization revealed hypertrophic cardiomyopathy with isolated obstruction of the right ventricular outflow tract, with a pressure gradient of 70 mmHg, but no obstruction in the left ventricle. He began daily treatment with 30 mg propranolol. At the age of 18, he was admitted for cardiac evaluation. An echocardiogram revealed left mid-ventricular and subpulmonic obstructions associated with pressure gradients of 88 mmHg and 65 mmHg, respectively. A single oral dose of 200 mg of cibenzoline decreased the pressure gradients in the left and right ventricles (38 mmHg and 36 mmHg, respectively). He was then given 300 mg daily of cibenzoline, and both pressure gradients remained low without any complications 8 months later at the time of discharge.     

Development of a New Device for Diagnosis of Hypoxemia and Arrhythmia by SaO2 ECG Holter Monitoring

Background: We have developed a system to monitor, simultaneously and continuously, ambulatory SaO₂ measured using a pulse-oximeter and ECG data for 24 hours. Methods: The ambulatory SaO₂-ECG monitoring system consisted of a portable monitoring device (SM50) with two channels for ECG data and one channel for SaO₂ data input; a sensor for SaO₂ recording; and a pulse-oximeter. An ambulatory monitoring analyzer was used. The SaO₂ report from the present analyzer included two types of data (i.e., a profile of heart rate [HR], pulse rate [PR], and SaO₂ value per min), and a trend graph of HR, arrhythmia, ST level and slope, PR, and SaO₂ per minute. We also designed and produced an analytical program to automatically remove noise errors relating to the SaO₂ measurement. Results: Using this system, we performed a clinical study on ten healthy volunteers (Group N) and seven patients with chronic pulmonary diseases (Group CPD) to evaluate the usefulness of the system as a diagnostic means for respiratory failure and arrhythmia. Group N showed a stable value of 90% or over in SaO₂ during the 24-hour monitoring while Group CPD showed values under 90% SaO₂ in all patients at rest during the night or after a 15-minute walk. Transient atrial tachycardia (TAT) was observed in 3 of 7 CPD patients, and each episode was preceded by a decrease of SaO₂. The occurrence of a single or double ventricular extrasystole was high in Group CPD compared with Group N (1.21 ± 0.89 vs 0.6%± 0.3%, P < 0.05), its occurrence was not associated with a decrease in SaO₂. Conclusions: In outpatients, especially patients who are taken care of at home, the present system will certainly contribute greatly to the diagnosis of respiratory failure and arrhythmia as well as to evaluate the effects on these diseases of therapy. In addition it is suggested that in CPD, patients’hypoxemia may induce TAT.     

ESHAP therapy effective in a patient with Langerhans cell sarcoma

We describe the rare case of a 53-year-old woman with systemic involvement of Langerhans cell sarcoma (LCS) who had undergone living-related liver transplantation. We chose the CHOP regimen as first-line chemotherapy, and clinical improvement of LCS was obtained. Intensive care was necessary due to the systemic involvement of LCS and severe infectious diseases. After the third cycle of CHOP therapy, however, disease progression was observed, and we administrated a modified ESHAP regimen (etoposide, carboplatin, cytarabine, methylprednisolone) as second-line therapy. A marked response was obtained after four cycles of this combination chemotherapy. Modified ESHAP may be a very effective combination chemotherapy regimen for LCS.     

CASE REPORT: Esophagogastric Varices Due to Arterioportal Shunt in a Serous Cystadenoma of the Pancreas in von Hippel-Lindau Disease

Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited disorder characterized by extensively vascularized tumors and cysts in specific organs. Angiogenesis is a striking future of VHL disease with its characteristic cysts and well-vascularized tumors. The hypervascular nature of VHL lesions has been linked to the overproduciton of vascular endothelial growth factor (VEGF) through increased expression of hypoxia inducible factor-1alpha (HIF-1alpha). Here we describe a rare case of VHL disease with esophageal and gastric varices due to arterioportal shunt in a serous cystadenoma of the pancreas, which, upon immunohistochemical examination, exhibited HIF-1alpha and VEGF expression. Rupture of esophageal varices was successfully treated with endoscopic injection sclerotherapy.     

Improvements in Artery Occlusion by Low‐Density Lipoprotein Apheresis in a Patient with Peripheral Arterial Disease

Abstract: Peripheral arterial disease (PAD; arteriosclerosis obliterans) shows ischemic symptoms along the peripheral arteries due to reduced blood flow, and the number of patients with PAD is increasing. Several papers have reported on the clinical effect of low‐density lipoprotein apheresis (LDL‐A) on PAD, but there has been no report so far on the improvement of total peripheral artery stenosis by LDL‐A. We report on the clinical course of a female PAD patient with intractable decubitus in her heel due to the complete occlusion of anterior tibial artery who was treated by a series of LDL‐A sessions. The complete occlusion of the anterior tibial artery improved as seen on angiography, and the decubitus in her heel also markedly improved after LDL‐A therapy. This report supports the clinical benefit of LDL‐A for the treatment of PAD.     

Pharmacokinetic analysis based on dynamic contrast-enhanced MRI for evaluating tumor response to preoperative therapy for oral cancer

Purpose:

To evaluate whether a pharmacokinetic analysis is useful for monitoring the response of oral cancer to chemoradiotherapy (CRT).

Materials and Methods:

Twenty‐nine patients were included. They underwent dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) before and after CRT. The DCE‐MRI data were analyzed using a Tofts and Kermode (TK) model. The histological evaluation of the effects of CRT was performed according to Ohboshi and Shimosato's classification.

Results:

None of the pre‐CRT parameters were significantly different between the responders and nonresponders. The post‐CRT volume of the extravascular extracellular space (EES) per unit volume of tissue (v_e) of responders (0.397 ± 0.080) was higher than that of nonresponders (0.281 ± 0.076) (P = 0.01). The change of the v_e between the pre‐ and post‐CRT of the responders (0.154 ± 0.093) was larger than that of the nonresponders (0.033 ± 0.073) (P = 0.001). Therefore, the increase in the v_e strongly suggested a good tumor response to CRT, which reflected an increase of the EES secondary to the destruction of the cancer nest. The changes in the volume transfer constant (K^trans) were significantly different between the responders and nonresponders (P = 0.018).

Conclusion:

Both the increase of the v_e and the elevation of permeability (K^trans) were indicative of a good tumor response to CRT. The pharmacokinetic analysis had potential for monitoring the histopathological response to CRT. J. Magn. Reson. Imaging 2012;36:589–597. © 2012 Wiley Periodicals, Inc.