Successful allotransplantation of cryopreserved tracheal grafts with preservation of the pars membranacea in nonhuman primates.

OBJECTIVE: This study was performed to confirm the feasibility of cryopreserved tracheal allotransplantation in primates, the anatomy and immunology of which are considered to be more closely related to those of humans than those of other animals. METHODS: Cryopreserved tracheal allotransplantations were performed in 3 recipient primates. In the control group fresh tracheal allotransplantations were performed in 2 primates (control A), and a tracheal allotransplantation with a simply frozen tracheal graft was performed in 1 primate (control B). Monthly bronchoscopic examinations, histologic examinations, electron microscopic examinations, and immunohistochemical investigations were performed in each of the primates. RESULTS: In the cryopreserved tracheal allotransplantation group, 3 recipient monkeys were killed on the 35th, 144th, and 387th postoperative days, respectively. All grafts were incorporated by the recipient trachea without stenosis in the cryopreserved group. In the control group 2 recipient monkeys were killed on the 93rd postoperative day (control A), and one was killed on the 84th postoperative day (control B). Severe stenosis was observed after the transplantation in all of the control monkeys. Immunologic reactions appeared to be attenuated by the cryopreservation, whereas T cell-mediated immunologic rejection (control A) and loss of cartilage viability (control B) were considered to be the causes of graft failure in the control group. CONCLUSION: The immunogenicity of the tracheal allografts was reduced by cryopreservation, and cryopreserved tracheal allotransplantation was successful in our primate model. Further investigation of cryopreserved tracheal allotransplantation with regard to proper clinical applications and the limitations of the procedure should be performed.     

Reconstruction of the inner site of the auricle with two local skin flaps.

The external auditory canal and the auricular concha were reconstructed with two local skin flaps after resection of a primary adenoid cystic carcinoma of the external auditory canal. The upper part of the inner site of the auricle was covered with a superiorly-based posterior skin flap and the lower part of it with an inferiorly-based anterior one. Both were cutaneous flaps with a random pattern of blood supply. At the same time the surgical field after the flaps had been raised made additional excision easy, including partial mastoidectomy and parotidectomy. After 10 years of the operation auricular disfigurements and recurrence of the tumour are not observed.     

Furuncle-like Lesions in Mouse Experimental Skin Infections with Staphylococcus aureus

The pathomechanism of furuncle has not been fully elucidated and should be investigated using an appropriate animal model. We observed the invasion of Staphylococcus aureus cells into hair follicles in mice, using a strain of S. aureus isolated from human furunculosis. Light microscopical examination revealed that S. aureus cells attached to corneocytes at 6 h after inoculation, proliferated around the ostium of the hair follicle and invaded the hair follicle at 12 h after inoculation. Electron microscopically, S. aureus cells attached to the horny layer of hair follicle with long, thick, string-like structures. At 12 h after inoculation, S. aureus cells invaded in a file between the inner root sheath and outer root sheath. We could not induce direct invasion from the follicle ostium. Our findings suggest that there are some regions of the hair follicle through which S. aureus cells can relatively easily invade deeper into the follicle. The most important question is what confines the invasion and inflammation of S. aureus to the hair follicle. We suggest that there is some locus minoris for invasion into hair follicles by S. aureus, such as an interface between the two sheaths.     

Herpes simplex viral pneumonia after coronary artery bypass grafting

We report a case of herpes simplex viral (HSV) pneumonia as a post-CABG pulmonary complication in a 70-year-old man. Chest radiography on postoperative day 9, showed a glass-like shadow and pleural effusion in the left lung field, and the man's condition began deteriorating rapidly. Bronchofiberscopy to detect the pathogen and a bronchoalveolar lavage with polymerase chain reaction (PCR) yielded a definitive diagnosis of HSV pneumonia. Once therapy with acyclovir was begun, his condition improved markedly. Our case suggest that 1 viral pulmonary infection should be considered as a possible cause in postoperative cardiac patients with unexplained progressive pulmonary infiltrates, and 2 DNA amplification using PCR is rapid—it can be completed within 1 day—and sensitive and specific in diagnosing such infections.     

Neonatal intrahepatic cholestasis with hepatic siderosis and steatosis

Abstract Neonatal intrahepatic cholestasis is a heterogeneous disease of undetermined cause. There is an unreported subset of idiopathic neonatal intrahepatic cholestasis with an unusual histological combination of hepatic siderosis and macrovesicular steatosis. The patients were a 34-day-old female and a 39-day-old male with normal birth weights. Their mothers had received oral iron supplement4–6 weeks before delivery. The patients had obstructive jaundice noticed at the well-baby clinic at 1 month of life. They had high levels of serum galactose and tyrosine, hyperferritinemia. Urinary organic acid and bile acid analyses were negative, and galactose-1-phosphate uridyltransferase activity in red cells was normal. Liver biopsies showed diffuse iron deposits and macrovesicular fat. By substituting formula milk with lactose-free milk, the patients responded, and had normal biochemical tests within 5 months of life. Follow-up biopsies, at the age of 12 months, showed mild residual fibrosis without iron or fat deposits. They are both well at 3 and 6 years of age, respectively, without biochemical liver dysfunction and neurologic impairment. Prenatal iron-overload might contribute to the pathogenesis of the disease, but further studies are needed to confirm the assumption.     

An epithelioma with hair follicle and apocrine differentiation

A tumor on the face showing follicular and apocrine differentiation is described. The coexistence of the two features suggests that the hair follicle has the potential to develop an apocrine gland tumor.     

Hepatectomy in a hepatocellular carcinoma case with Dubin–Johnson syndrome and indocyanine green excretory defect

A 77-year-old male patient with history of jaundice was referred to our hospital for treatment of hepatocellular carcinoma (HCC). He was found to have Dubin–Johnson syndrome (DJS), a clinical feature of constitutional jaundice with conjugated hyperbilirubinemia, and indocyanine green (ICG) excretory defect, both of which are rare conditions. Total bilirubin was 5.1 mg/dl and ICG retention at 15 min (ICGR15) (77.1 %). Converted ICGR15 from GSA scintigraphy was 15.9 %. Resection of the medial segment and ventral region of the anterior segment of the liver as well as cholecystectomy were performed. The background of the liver tissue was blackish yellow and consistent with DJS and chronic hepatitis. Although total bilirubin level increased to 8.2 mg/dl on the 2nd postoperative day, the patient ultimately recovered and he was discharged on the 14th day. His 1- and 2-year medical checkups indicated recurrence of HCC. He underwent transarterial chemoembolization and is presently doing well 39 months after surgery. We report here on evaluation and treatment of patients with such disorders.     

MUC2 expression and prevalence of high-grade dysplasia and invasive carcinoma in mixed-type intraductal papillary mucinous neoplasm of the pancreas

Background/objectivesMorphological types and mucin protein expressions classify intraductal papillary mucinous neoplasms (IPMNs). Main duct (MD)-IPMN mostly consists of intestinal type (I-type), which expresses MUC2. Branch duct (BD)-IPMN mostly consists of gastric type (G-type), which does not express MUC2. However, the definition of mixed-type IPMN has yet to be clarified and it contains various histological types. The aim of this study was to investigate the relationship between MUC2 expression and the presence of high-grade dysplasia (HGD) and invasive carcinoma, especially in mixed-type IPMN.MethodsThis retrospective study included 101 consecutive patients with surgically resected IPMNs between April 2001 and October 2012. All patients were morphologically classified into four distinct types (I-type, G-type, PB-type: pancreatobilliary, O-type: oncocytic) and immunohistochemical reactivity of various anti-mucin antibodies were investigated.ResultsAccording to the classification of the 2012 international guidelines, the numbers (and histomorphological types: I/G/PB/O) of MD, mixed-type, and BD-IPMNs were 16 (12/4/0/0), 45 (16/28/1/0), and 40 (0/38/1/1). Prevalence of MUC2 expression in MD, mixed-type, and BD-IPMNs were 75% (12/16), 36% (16/45), and 0% (0/40). In mixed-type IPMN, the prevalence of HGD and/or invasive carcinoma in MUC2-positive IPMN was significantly higher than that of MUC2-negative IPMN (HGD + invasive carcinoma: 88% vs. 38%, p = 0.0017; invasive carcinoma: 50% vs. 21%, p = 0.042). Multivariate analysis showed that MUC2 expression is an independent predictive factor of HGD and invasive carcinoma in mixed IPMN (odds ratio 14.6, 95% CI 2.5–87.4, p = 0.003).ConclusionsIn mixed-type IPMN, MUC2 expression clearly identified HGD and invasive carcinoma and may provide most appropriate surgical indication.