Risk factors for revision total hip arthroplasty: emphasis on the characteristics of Japanese lifestyle

Introduction  

Total hip arthroplasty (THA) is a common technique for increasing quality of life (QOL) in patients with degenerative or traumatic hip arthropathy. However, there is always a risk of THA requiring revision. The present study aimed to develop guidelines for QOL assessment and patient education by analyzing the risk factors for revision THA.     

The dynamics and clinical significance of alpha 2 plasmin inhibitor-plasmin complex and thrombin-antithrombin complex in postoperative pleural effusion following a pulmonary lobectomy

Purpose  The overall incidence of postoperative alveolar air leakage (AAL) remains high; however, the mechanism regarding how to adequately heal such postoperative AAL remains to be elucidated. The aim of this study was to determine any correlations between the activity of the fibrinolytic and coagulation system in the postoperative pleural effusion and appearance or disappearance of postoperative AAL. Methods  This study prospectively investigated 25 patients who underwent a pulmonary lobectomy from July 2005 to March 2006. Pleural effusion was collected through the chest tube. Alpha 2 plasmin inhibitor-plasmin complex (PIC), as a fibrinolytic marker, and thrombin-antithrombin complex (TAT), as a coagulation marker, were measured. Results  The activity of the coagulation system was higher than that of the fibrinolytic system. The concentration of TAT tended to increase (3rd vs 4th postoperative day [POD], P = 0.0907). The mean time of appearance and disappearance of postoperative AAL was 1.4 days and 3.2 days, respectively. The patients with postoperative AAL had a TAT level significantly below the average on the 3rd POD in comparison to the patients without postoperative AAL (P = 0.0163). Moreover, the concentration of TAT in patients with postoperative AAL was significantly lower than that in patients without postoperative AAL (1824.0 ± 137.3 ng/ml vs 3444.0 ± 287.6 ng/ml, P = 0.0113) on the 3rd POD. On the 4th POD, the concentration of TAT was almost same and there was no significance (P = 0.6759). Conclusions  This study demonstrated for the first time the course of the fibrinolytic and coagulation activity in the pleural effusion after a pulmonary lobectomy, and showed that the delayed activity of the coagulation system is associated with the appearance of the postoperative AAL.     

Interleukin-10 correlates with oxidized low density lipoprotein in coronary culprit plaques

Inflammation and oxidation play crucial roles in plaque instability. We immunohistochemically assessed expression of the anti-inflammatory cytokine interleukin (IL)-10, and of oxidized low density lipoprotein (ox-LDL) in coronary atherectomy specimens from 19 and 18 patients with stable and unstable angina, respectively. Immunopositive areas for IL-10 and ox-LDL were significantly greater in the group with unstable angina (p < 0.05, each), and they positively correlated (r = 0.452, p < 0.005). These results suggest that IL-10 plays an anti-inflammatory role in atherosclerotic lesions and modulates the inflammatory process in unstable coronary plaque.

Conflict of interest

None     

Both Fibrous Capsule Formation and Extracapsular Penetration Are Powerful Predictors of Poor Survival in Human Hepatocellular Carcinoma: A Histological Assessment of 365 Patients in Japan

Background  A new definition of infiltration to the capsule (fc-inf) has been proposed as a novel marker for predicting the prognosis of 88 patients with hepatocellular carcinoma (HCC). The current aim was to present evidence to develop the fibrous capsule and fc-inf, from the Japanese histological findings for HCC, and to validate their biological significances and predictive power of survival in a large series. Methods  A total of 365 HCCs were divided into HCCs without the fibrous capsule (NC type; n = 135) and HCCs with the fibrous capsule (FC type; n = 230). Then, FC type was subclassified into two types: extracapsular infiltrating (EC) type (n = 125), in which cancer cells penetrated outside the fibrous capsule, and intracapsular (IC) type (n = 105), in which the infiltrating cancer cells stayed inside the fibrous capsule. Results  The proportion of less histological differentiation and portal venous invasion was higher in FC type than in NC type. The fibrous capsule came to be observed according to the increase of tumor size (P < 0.0001). FC type had significantly poorer outcome for overall survival than NC type (P = 0.0022). EC type showed more intrahepatic metastasis than IC type. The macroscopic subclassifications were significantly affected the presence of fc-inf. EC type had significantly poorer outcome for disease-free survival than IC type (P = 0.0132) and was an independent prognostic factor for disease-free survival (P = 0.0482). Conclusions  Fc-inf defined as extracapsular penetration was verified to be a novel marker for predicting prognosis, and presence of fc-inf might be predicted by tumor gross features.     

Parastomal hernia with incarcerated necrosis at ascending colon 18 years after the construction of ileal conduit: a case report

A 78-year-old woman had undergone radical cystectomy and construction of ileal conduit because of bladder cancer in 1988. Eighteen years after the operation, she was referred to our hospital with the chief complaint of abdominal pain and oliguria. She had a mass just superolateral to the stoma with tenderness and reddish skin. Abdominal X-ray and computed tomographic scanning showed free air and peristomal intestinal dilation in the subcutaneous area. With a diagnosis of incarcerated parastomal hernia and intestinal perforation, emergency operation was performed. The orifice of the hernia was located in the superolateral aspect of the stoma. The ascending colon was locally necrotic and perforated. Usually, the orifice of parastomal hernia is so wide that incarceration rarely occurs. Parastomal hernia treated with emergency operation is rare, with only 9 cases, including our case, reported in the Japanese literature. Three cases had ileal conduit, and the content of the hernia was the ascending colon only in our case.     

A case of papillary cystadenoma of the epididymis

A 74-year-old man who consulted our hospital complaining of painless left scrotal swelling. Computed tomographic demonstrated a left epididymal tumor in the hydrocele. We performed left high orchiectomy. Microscopically, several microcysts were found and tumor cells showing a papillary growth pattern were found in these microcysts. We finally diagnosed the patient as having papillary cystadenoma of the epididymis. Papillary cystadenoma of the epididymis is rare epididymal benign tumor. To our knowledge, 19 cases have been reported in Japan between 1976 and 2000. It is clinically important to determine whether or not the tumor is associated with von Hippel-Lindau disease. In our case, there was no evidence of von Hippel-Lindau disease and the patient has remained well with no complication to date.     

Esophageal fibrovascular polyp removed by cervical esophagotomy

We report a case of esophageal fibrovascular polyp (FVP) removed by cervical esophagotomy. The patient was a 74-year-old man in whom an intraesophageal mass was detected by a chest CT examination during a complete medical check-up. An upper gastrointestinal series showed a large, pedunculated, cervical esophageal mass for which our preoperative diagnosis was a FVP. We studied its features, as well as removal procedures in 45 patients in the literature. Most patients had marked symptoms, but ours had no complaints, and so this case may be a rare one. Various removal procedures were reported, but thoracotomy and esophagectomy are considered to be the inappropriate procedures since FVP is a benign disorder.