Leaflet escape in an Edwards TEKNA mitral prosthesis

In almost every type of artificial valve, structural failure has been described. We are reporting on a case of a sudden leaflet escape of an Edwards TEKNA mitral valve prosthesis 12 years after implantation. The patient had a sudden onset of dyspnea and severe pulmonary edema with subsequent cardiogenic shock. An emergency mitral replacement was successfully performed. A multi-detector computed tomography scanning and three-dimensional imaging showed two fragments that had embolized in the terminal aorta and the left common iliac artery. The patient presented visual field abnormality, and postoperative head computed tomography showed watershed cerebral infarction. The escaped leaflet that fractured transversely was removed, following the patient’s recovery, during cardiac surgery.     

Subcutaneous porocarcinoma clinically presenting as a soft tissue tumor

Porocarcinoma is a rare malignancy with glandular adnexal differentiation. A 38‐year‐old Japanese man noticed a subcutaneous mass in right inguinal region about 20 years prior to being examined. Radiological examinations demonstrated the mass, 11 × 10 cm in size, was in the subcutaneous fat tissue. Recently, the mass grew rapidly, and it was biopsied by an orthopedist based on clinical diagnosis of primary soft tissue tumor. Histopathological examination of the resected specimens also revealed that the tumor lacked involvement to the skin. Microscopically, the tumor was mainly composed of poroid cells with partially obvious squamous differentiation, accompanied by focal ductal structures immunoreactive for CEA and EMA. The tumor contained a low‐grade area consisting of poroid cells and high‐grade area with squamous differentiation. This histopathological heterogeneity suggested malignant transformation from poroma. The patient had the tumor in almost same size over the period of 20 years, which is the longest in the previous reports. This unique case of subcutaneous porocarcinoma is reported.     

Primary cutaneous localized/clearly-outlined true histiocytic sarcoma: Two long-term follow-up cases

Histiocytic sarcoma (HS) is a rare hematopoietic tumor that mainly involves extranodal sites, including the intestinal tract, skin, soft tissues and other organs. It is well known as an aggressive neoplasm that shows a poor response to therapy. However, a subset of patients with resectable disease has shown a favorable outcome with surgical treatment. Primary cutaneous HS is exceedingly rare and, to date, its long-term prognosis has thus not been well described. Here, we highlight two cases of primary cutaneous HS that showed long-term survival. Case 1 was a healthy 47-year-old woman who found a 12-mm tumor on her forehead. Case 2 was a 66-year-old woman, under follow up of a myxoid liposarcoma in her leg, who presented with a 25-mm tumor in her hypothenar eminence. Histologically, the tumors in both cases had a smooth outline with proliferating atypical tumor cells that showed histiocytic differentiation as revealed by immunohistochemistry with antibodies to CD68 (KP-1) and lysozyme in case 1; and CD68, lysozyme and CD163 in case 2. Tumor cells in case 1 had a monotonous appearance. After complete resection, cases 1 and 2 have survived for 10 and 4 years, respectively, without recurrence. To date, such patients are relatively long follow-up cases of survival from HS and highlight how a clear outline of the primary cutaneous HS tumor may be associated with its resectability and be an important factor in the assessment of its curability.     

Recent Advances and Future Directions of Hypothermia Therapy for Traumatic Brain Injury

For severe traumatic brain injury (TBI) patients, no effective treatment method replacing hypothermia therapy has emerged, and hypothermia therapy still plays the major role. To increase its efficacy, first, early introduction is important. Since there are diverse pathologies of severe TBI, it is necessary to appropriately control the temperature in the hypothermia maintenance and rewarming phases by monitoring relative to the pathology. Currently, hypothermia is considered appropriate for severe TBI patients requiring craniotomy for removal of hematoma, while induced normothermia is appropriate for severe TBI patients with diffuse brain injury. Induced normothermia is expected to exhibit a cerebroprotective effect equivalent to hypothermia, as well as reduce the complexity of whole-body management and systemic complications. According to the Japan Neurotrauma Data Bank of the Japan Society of Neurotraumatology, the brain temperature was controlled in 43.9% of severe TBI patients (induced normothermia: 32.2%, hypothermia: 11.7%) in Japan. Brain temperature management was performed mainly in young patients, and the outcome on discharge was favorable in patients who received brain temperature management. Particularly, patients who need craniotomy for removal of hematoma were a good indication of therapeutic hypothermia. Improvement of therapeutic outcomes with widespread temperature management in TBI patients is expected.     

Changes in lip forms on three-dimensional images with alteration of lip support and/or occlusal vertical dimension in complete denture wearers

PurposeThis study aimed to examine changes in the lip form, oral fissure form and vermilion height of complete denture wearers resulting from altered occlusal vertical dimension (OVD) and/or lip support.MethodsThree-dimensional facial images of 10 edentulous patients (four males and six females) when wearing six experimental record blocks (ExpRBs) with varying OVD and/or lip support were analyzed. Analysis was performed using three landmarks on the mid-line (labrale superius (ls), stomion (sto), and labrale inferius (li)) and two landmarks on the oral fissure (at points 20 mm right and left of the midline (r-OFP and l-OFP, respectively)). Curvature of the oral fissure (COF) in the frontal view was evaluated by calculating the difference between sto and the average of r-OFP and l-OFP (avrl-OFP). The vermilion height in the frontal view was calculated as the distance from sto to ls and li. In 10 subjects, comparison between standard ExpRB and test ExpRBs with altered OVD and/or lip support was performed by calculating differences between these data.ResultsThe ls, sto, and li landmarks changed with alteration of OVD and/or lip support, whereas avrl-OFP changed vertically with alteration of lip support and anteroposteriorly with alteration of OVD and/or lip support. COF and vermilion height were affected by alterations in OVD and/or lip support.ConclusionDeficient OVD with extensive lip support can curve the oral fissure form upward, and deficient OVD with deficient lip support can reduce the vermilion height.