Occupational and environmental factors and idiopathic pulmonary fibrosis in Japan

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease of unknown etiology. Environmental factors, especially occupational agents, may be of great importance in the manifestation of IPF. We examined the relationship between occupational and environmental factors and IPF in Japan. A multicenter hospital-based case-control study was performed in 2001. Included were 102 cases aged 40 years or over who were within 2 years of having been diagnosed in accordance with the most recent criteria. Controls, aged 40 years or over, were 55 hospitalized patients diagnosed as having acute bacterial pneumonia and four outpatients with common colds. Data on occupational and environmental factors were obtained from a questionnaire. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of IPF for single factors with adjustment for age, sex and region. Compared with controls, cases were more likely to have been managers, officials or production workers and less likely to have been protective service or materials handling workers. Clerical and related work was significantly related to a decreased risk of IPF after further adjustment for pack-years of smoking (OR = 0.42; 95% CI = 0.18-0.95). Exposure to metal dust was significantly associated with an increased risk of IPF (OR = 9.55; 95% CI = 1.68-181.12). From 20.0 to 39.9 pack-years of smoking was significantly associated with an increased risk of IPF (OR = 3.23; 95% CI = 1.01-10.84). Our results appear to confirm data from previous epidemiologic studies. Metal dust exposure may be a particularly important risk factor for IPF.     

Infective endocarditis developing as uremia

A 49-year-old man presented with fever and uremic symptoms such as general malaise, leg edema and decreased urine output. He was diagnosed as having infective endocarditis (IE) accompanied by renal failure. Although he had been receiving hemodialysis for a long time, renal function dramatically improved after heart valve replacement. This case suggests that uremia can develop as an initial manifestation of IE and removal of an infected heart valve can improve renal function despite persistent renal failure. From the perspective of recovery of renal function, early surgery should be considered in patients with renal failure following IE.     

Expression of tight and gap junctional proteins in the perineurial window model of the rat sciatic nerve

Limited perineurial injury, known as a perineurial window, can lead to neuropathic pain. This article hypothesizes that the recovery of the perineurium is associated with the intercellular junctional proteins. It analyzes the expressions of occludin, ZO-1, and connexin 43 by immunoconfocal microscopy. Seven days after injury, immunoreactivities for occludin and ZO-1 were observed, although there was no connexin 43 detected. Then, 21 days after injury, immunoreactivity for connexin 43 were observed. These results indicate that recovery of the perineurium is associated with the intercellular junctional proteins and that the recovery of gap junctions is delayed compared with that of tight junctions.     

Management of vaginal erosion of polypropylene mesh slings

PURPOSE: The SPARC (American Medical Systems, Minneapolis, Minnesota) polypropylene sling has recently been introduced as an alternative delivery system to TVT (Ethicon, New Brunswick, New Jersey) tension-free vaginal tape for placement of a tension-free mid urethral sling. Erosion must always be considered a risk of synthetic materials. We present 4 cases of vaginal erosion of polypropylene mesh placed with this system and the successful conservative management done. MATERIALS AND METHODS: A total of 90 patients received a SPARC polypropylene pubovaginal sling at our institution between October 1, 2001 and October 1, 2002. During followup 3 of our patients and 1 patient with tension-free vaginal tape who was referred from elsewhere presented with vaginal exposure of the mesh. RESULTS: Two patients described persistent vaginal discharge 6 weeks postoperatively, including 1 who complained primarily of partner discomfort during sexual intercourse. Two patients were completely asymptomatic and mesh erosion was discovered at routine physical examination 6 weeks postoperatively. Pelvic examination demonstrated vaginal exposure of the mesh in all cases. Each patient was observed conservatively and 3 months postoperatively all 4 had complete spontaneous epithelialization over the mesh. None had stress incontinence, urgency or urge incontinence, all emptied the bladder to completion and all patients were completely satisfied with the procedure. CONCLUSIONS: The recent literature suggests that polypropylene mesh erosion should be treated with complete removal of the sling material. We present 4 cases of vaginal erosion of polypropylene slings that were managed conservatively with observation and resulted in complete spontaneous healing. Sling preservation with continued patient continence and satisfaction is a feasible option in those with vaginal exposure of polypropylene mesh.