A case of a choledochal cyst associated with a lymphatic infiltration of a hyperplastic gallbladder epithelium

A 4-year-old girl with a congenital choledochal cyst (Todani IV-A, Komi type A) underwent a resection of the dilated common bile duct and gallbladder. Histologic studies of the gallbladder showed a general hyperplastic change associated with cribriform proliferation at the gland base of the gallbladder. In this region, clusters of cribriform glands were found within the lymphatic vessels, compatible with lymphatic infiltration of tumor cells. However, careful histologic studies did not reveal any apparent neoplastic changes in the gallbladder and common bile duct, so a final diagnosis of epithelial atypism with reactive hypertrophy was made. The displacements observed in the lymphatics are just an incidental finding in a proliferative process of the hyperplastic gallbladder epithelium. In the follow-up observation for 3 years, the patient is doing well without evidence of tumor recurrence. These results suggest that a mere lymphatic infiltration of hyperplastic gallbladder epithelium should not be directly considered as evidence of carcinogenesis.     

An Aqueous,Electrolyte‐Type,Rechargeable Device Utilizing a Hydrophilic Radical Polymer‐Cathode

A hydrophilic poly(vinyl ether)‐backbone polymer bearing a pendant TEMPO radical, poly(2,2,6,6‐tetramethylpiperidinyloxy‐4‐yl vinyl ether) (PTVE), was designed as a cathode‐active material, which displays a reversible one‐electron redox capability, even in an aqueous electrolyte. The PTVE layer coated on a current collector demonstrated a rapid charging‐discharging rate based on the combination of the redox‐active nitroxide radicals built into the hydrophilic polymer and the aqueous electrolyte that possessed a high electrical conductivity. A test cell fabricated with a PTVE cathode, a zinc anode, and an aqueous electrolyte gave an output voltage of 1.7 V and showed the ability to be recharged more than 500 times rechargeability.

     

TNFα Gene Silencing Reduced Lipopolysaccharide-Promoted Proliferation of Endometriotic Stromal Cells

Problem  We previously reported that lipopolysaccharide (LPS)-promoted endometriotic stromal cell (ESC) proliferation by inducing TNFα production. The aim of this study was to investigate the efficacy of TNFα gene silencing on LPS-treated ESCs.
Method of study  Endometriotic stromal cells (ESCs) and endometrial stromal cells (ESCs) (EMSCs) were obtained from ovarian chocolate cysts and uterine myoma, respectively. Using PCR array, LPS-induced gene expression profiling after transfection of TNFα siRNA into ESCs was performed. Down-regulated genes by TNFα silencing were examined using real-time RT-PCR. Effect of TNFα silencing was examined using ELISA and BrdU incorporation, respectively.
Results  In PCR array, TNFα silencing in ESCs repressed LPS-induced expression of cIAP2 and IL-8, NFκB pathway responsive genes. After adding LPS, the levels of cIAP2 and IL-8 expression in ESCs were higher compared with those in EMSCs. TNFα silencing attenuated the LPS-induced ESC proliferation.
Conclusion  Tumor necrosis factor α may be involved in cell proliferation of endometriotic tissues.     

Follicular dendritic cell sarcoma with microtubuloreticular structure and virus-like particle production in vitro

Neoplasm of follicular dendritic cells (FDC), follicular dendritic cell sarcoma (FDCS), is a rare tumor of intermediate to high-grade malignancy in lymph nodes and visceral organs. Reported herein is a case of FDCS arising from cervical lymph nodes in a 16-year-old Japanese boy, who died of the disease 3 years after diagnosis. The tumor cells were pale eosinophilic and elongated with euchromatic nuclei and were positive for CD21, clusterin, and CNA-42 on immunohistochemistry, as well as desmosome-like junctions on electron microscopy. The presence of microtubuloreticular structures (MTRS) in the tumor cells and associated lymphocytes characterized this case, suggesting some viral infection, although qualitative polymerase chain reaction of genomic and complementary DNA obtained from the tumor failed to demonstrate any viral infection at the laboratory level. The stimulation of dispersed tumor cells and peripheral blood mononuclear cells with mAb to CD3 and interleukin-2 was attempted; and the cell line established by the authors (FDCS-Sa) was stimulated with iododeoxyuridine. Virus-like particles (VLP) were successfully induced from each cellular source. The VLP, 100 nm in diameter, showed an electron-dense thorny envelope and granular core. This is the first case of FDCS with MTRS accompanying VLP production in vitro .     

Distribution of certified perfusionists in core training institutions accredited by the Japanese Board of Cardiovascular Surgery in Japan

In 2008, the 22nd qualifying examination for certified perfusionist was conducted on extracorporeal circulation techniques. A total of 647 people had passed the qualifying examination and become certified perfusionists by the end of 2008.     

Successful effect of triple blockade of renin–angiotensin–aldosterone system on massive proteinuria in a patient with chronic kidney disease

A patient with chronic kidney disease (CKD) due to membranous nephropathy with daily urinary protein excretion exceeding 5 g did not respond well to dual therapy with an angiotensin converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB). Addition of the mineralocorticoid receptor blocker (MRB), spironolactone, led to moderate reduction in daily urinary protein excretion. However, spironolactone had to be inevitably discontinued due to gynecomastia. Replacement of spironolactone with the selective MRB, eplerenone, added to the preceding treatment with ACE-I and ARB, resulted in remarkable reduction of daily urinary protein excretion to less than 0.2 g. This case suggests that triple blockade of renin–angiotensin–aldosterone (RAA) system with ACE-I, ARB, and MRB could be useful for CKD patients with massive proteinuria.     

Effects of cholinesterase inhibition in supraspinal and spinal neural pathways on the micturition reflex in rats

OBJECTIVE

To investigate whether activation of brain and spinal cholinergic pathways affects the micturition reflex in rats.

MATERIALS AND METHODS

The effects of intracerebroventricular (i.c.v.) or intrathecal (i.t.) administration of neostigmine as a cholinesterase inhibitor and oxotremorine‐M (OXO‐M) as a muscarinic acetylcholine receptor (mAChRs) agonist, on the micturition reflex were evaluated by infusion cystometrography (CMG) in urethane‐anaesthetized untreated rats or rats pretreated with capsaicin.

RESULTS

Neostigmine injected i.c.v. increased bladder capacity (BC) and pressure threshold (PT) dose‐dependently, with an increase in maximum voiding pressure (MVP) and a decrease in voiding efficiency (VE) at higher doses. Also, neostigmine injected i.t. increased the BC and PT dose‐dependently without changing MVP or VE, and these effects were not apparent in capsaicin‐pretreated rats. In both routes, atropine as an antagonist of mAChRs, but not mecamylamine as a nicotinic‐AChR antagonist, almost completely antagonized the effects of neostigmine. The rank order of potencies of the antagonists for increasing effects of BC induced by 1 nmol of neostigmine was: pirenzepine (an M₁ mAChR antagonist) = atropine > 4‐DAMP (an M₃ mAChR antagonist) >> methoctramine (an M₂ mAChR antagonist) and tropicamide (an M₄ mAChR antagonist) via the i.c.v. route; and atropine > methoctramine > pirenzepine > tropicamide and 4‐DAMP via the i.t. route, respectively. OXO‐M injected via i.c.v. and i.t. had the same effects on BC, PT, MVP and VE as neostigmine by i.c.v. and i.t., respectively.

CONCLUSIONS

These results indicate that activation of muscarinic cholinergic mechanisms by the cholinesterase inhibitor in the brain and spinal cord can inhibit the micturition reflex, mainly by affecting afferent pathways. These mAChR‐induced inhibitory effects seem to be mediated through M₁/M₃ receptor subtypes in the brain, while in the spinal cord, the M₁/M₂ receptor subtypes might be involved in inhibitory effects, which are mediated via inhibition of mechanoceptive C‐fibre afferent pathways.     

An infected pseudoaneurysm following a modified Blalock-Taussig shunt

A two-month-old male infant with tetralogy of Fallot underwent a right-sided modified Blalock-Taussig shunt using a 4 mm expanded polytetrafluoroethylene graft through a right thoracotomy. Five months later, the patient developed otitis media, followed by repeated relapses of pneumonia and fever of unknown origin. Multidetector-row computed tomography and angiography, performed at 12 months of age, revealed a pseudoaneurysm of the subclavian artery at the insertion of the modified Blalock-Taussig shunt. After 20 days of antibiotic therapy, the pseudoaneurysm and infected graft were successfully resected through a median sternotomy approach. This report describes the treatment strategy of this rare but potentially fatal complication after a modified Blalock-Taussig shunt operation.