Effect of graft adaptation of the internal mammary artery on longitudinal phasic blood flow velocity characteristics after surgery

Left internal mammary artery (LIMA) bypass conduits undergo gradual longitudinal flow transition from the proximal to distal segments, and the diastolic/systolic (D/S) ratios of the flow indices can diagnose graft patency. However, the influence of graft adaptation on this has not been studied. We examined 46 patients with LIMA graft to the left anterior descending artery using a Doppler-tipped guidewire in the proximal, middle, and distal segments; 34 had patent LIMAs (group A: new LIMAs; <1 month postoperatively; n = 22 and group B: old LIMAs; ≥1 month postoperatively; n = 12), and 12 had new LIMAs with distal stenosis (group C). In diastole, the time-averaged peak velocities, maximum peak velocities, and velocity–time integrals in each segment were significantly greater in group A than in groups B or C; however, in systole, they did not differ significantly among the three groups. The D/S ratios of the indices in all segments in group A were significantly greater than those in groups B or C; however, they did not differ between groups B and C in any of the segments. Graft adaptation of a patent LIMA, itself, affects the longitudinal flow transition pattern. The D/S ratio of the three indices in the patent old LIMAs did not differ from those in the LIMAs with distal stenosis early after surgery. The timing of LIMA flow assessment must be considered during assessment of the graft patency from the flow velocity patterns.     

Case of adenomatid odontogenic tumor during pregnancy

Adenomatoid odontogenic tumor (AOT) is a relatively rare benign tumor, accounting for 2% to 7% of odontogenic tumors. AOT is generally found in the incisor region of the maxilla of young women. It is often misdiagnosed as a dentigerous cyst. We report a case of AOT during pregnancy. The patient was a 21-year-old Philippine woman who complained of a swelling in the right maxillary gingival; the swelling rapidly enlarged during pregnancy. We enucleated the tumor and the impacted canine, with the patient under general anesthesia. Histological examination revealed a pseudoglandular structure with odontogenic appearance. On the basis of these findings and the World health organization (WHO) classification, we diagnosed the tumor as an adenomatoid odontogenic tumor. The tumor cells were identified by an immunohistochemically positive reaction for Bcl-2 and estrogen receptor. The MIB-1 labeling index was less than 1%. There has been no sign of recurrence as of 1.5 years after the operation.     

Torsion of the gallbladder in a 3-year-old infant

A 3-year-old girl was admitted to hospital with complaints of severe upper abdominal pain and vomiting. On admission, a board-like rigidity in the right hypochondrium was noted, along with a high white blood cell count and a high C-reactive protein value. Abdominal ultrasonography (US) revealed a left-sided enlarged gallbladder with a thickened wall, without gallstones. Contrast-enhanced computed tomography (CT) demonstrated an enlarged gallbladder without enhancement effects and a cystic duct located on the right side of the gallbladder. The patient underwent an emergency operation following a diagnosis of torsion of the gallbladder. The gallbladder appeared gangrenous, and 180° clockwise torsion was found at the neck of the gallbladder. The gallbladder was straightened and then removed without difficulty because there was only slight inflammation around Calot’s triangle and the gallbladder was not fixed to the liver. Histopathological examination revealed an acute bleeding infarction of the gallbladder. The patient was discharged on the ninth day after surgery, without any complications. The present case suggested that abdominal US and contrast-enhanced CT examinations are helpful in making a correct diagnosis of torsion of the gallbladder even in an infant; in the event of this diagnosis, prompt cholecystectomy is necessary.     

Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery

Objective  

Repair of a cerebrospinal fluid (CSF) leak after transsphenoidal surgery (TSS) is usually accomplished using various graft materials. These methods are effective in most, but not all, cases.     

Perforin gene mutations in adult-onset hemophagocytic lymphohistiocytosis

Perforin gene (PRF1) mutations cause the primary form of hemophagocytic lymphohistiocytosis (HLH). We report a genetic defect of PRF1 in a 62-year-old Japanese man with recurrent episodes of HLH. Sequencing of PRF1 from both peripheral blood mononuclear cells and nail clippings showed compound heterozygous mutation, including deletion of two base pairs at codons 1090 and 1091 (1090-1091delCT) and guanine-to-adenine conversion at nucleotide position 916 (916GAEA). Although primary HLH has been detected in infants and children, genetic mutation of PRF1 or other genes should be considered a differential diagnosis of HLH even in the elderly.     

Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group

Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4(+) cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.     

Clinical significance of high-sensitivity C-reactive protein in lifestyle-related disease and metabolic syndrome

OBJECTIVES: High-sensitivity C-reactive protein (hs-CRP), a biochemical marker of subclinical inflammation, is associated with atherosclerosis and cardiovascular disease. The present study evaluated the clinical usefulness of hs-CRP in lifestyle-related diseases and metabolic syndrome. METHODS: Hs-CRP was measured in 407 subjects who underwent a checkup at our Medical Office of Cardiology. Levels of hs-CRP were compared between various clinical conditions associated with lifestyle-related diseases and metabolic syndrome. RESULTS: Levels of hs-CRP were significantly high in the subjects with hypertension, hyperlipidemia, diabetes, obesity, and metabolic syndrome (p < 0.001). Both diabetes and metabolic syndrome were strongly associated with hs-CRP levels (diabetes: p = 0.0001, beta = 0.184; metabolic syndrome: p < 0.00001, beta = 0.264). In addition, hs-CRP levels were strongly associated with number of risk factors, and hs-CRP levels were significantly increased with increased number of risk factors. In patients with many risk factors, levels of hs-CRP were significantly higher in subjects with abdominal obesity than in normal subjects (p < 0.001). Waist circumference and hemoglobin A1c levels represented independent predictors for hs-CRP levels in subjects with metabolic syndrome (waist circumference: p < 0.00001, beta = 0.256; hemoglobin A1c: p < 0.00001, beta = 0.242). CONCLUSIONS: Levels of hs-CRP were strongly associated with lifestyle-related diseases, metabolic syndrome, and increased number of risk factors. These results suggest that measurement of hs-CRP may be useful in risk management for clinical practice.