Cholangiocarcinoma arising from preexisting biliary hamartoma of liver--report of a case

We describe the case of a 72-year-old asymptomatic man with a cholangiocarcinoma arising from a biliary hamartoma, also referred to as "von Meyenburg's complex". The patient was clinically diagnosed as having a cystadenocarcinoma, but the tumor had already been present as a uniformly low-density area on computed tomography taken four years previously, as revealed by retrospective examination of the computed tomography films that had been taken annually after surgery for pulmonary emphysema. The low-density area had continued to enlarge year after year, and a high-density area was observed to have emerged inside the low-density area on computed tomography. Histopathological examination demonstrated that the high-density area corresponded to the cholangiocarcinoma and the low-density area to a biliary hamartoma. This is the first case in which it was possible to confirm the presence of cholangiocarcinoma inside a biliary hamartoma that had continued to increase in size.     

Pathological findings of the aortic homograft in a patient with tetralogy of Fallot twenty years after implantation

Summary We report pathological findings of the aortic homograft in a 27-year-old patient who died 20 years after implantation at the time of correction of tetralogy of Fallot. Although calcification of the homograft was severe with degeneration of valve leaflets, no functional obstruction of the homograft was found as a conduit. This observation may suggest a beneficial aspect of the aortic homograft as the right ventricle to the pulmonary artery conduit late after corrective surgery even if calcification was not avoided.     

Mild decrease in heart rate during early phase of targeted temperature management following tachycardia on admission is associated with unfavorable neurological outcomes after severe traumatic brain injury: a post hoc analysis of a multicenter randomized controlled trial

Background

The association between isolated admission heart rate (HR) and prognosis has been discussed, but not that between gross HR change and neurological outcome in patients with severe traumatic brain injury (TBI). In the acute phase of severe TBI, HR is influenced by several factors (e.g., pain, sympathetic activation, hypovolemia, fever, body temperature). Therefore, admission HR and gross HR change should be examined in patients with TBI treated with a well-designed protocol, such as was done in the Brain Hypothermia (B-HYPO) Study.

Methods

This was a post hoc analysis of the B-HYPO Study, which was conducted as a prospective, multicenter, randomized controlled trial in patients with severe TBI receiving mild therapeutic hypothermia (MTH; 32.0?°C–34.0?°C) or fever control (35.5?°C–37.0?°C) in Japan. Patients with MTH were examined, and HR change (%HR) in the early MTH phase was calculated as follows: [admission HR – HR at day 1]/admission HR?×?100. Patients were divided into six groups, using admission HR (<?80, 80–99, ≤?100) and median of %HR; i.e., group (Admission HR <?80 and %HR ≥?18.6); group (Admission HR <?80 and %HR <?18.6); group (Admission HR 80–99 and %HR ≥?18.6); group (Admission HR 80–99 and %HR <?18.6); group (Admission HR ≥100 and %HR ≥?18.6); and group (Admission HR ≥100 and %HR <?18.6). The primary outcome was an adjusted predicted probability of unfavorable neurological outcome at 6 months after TBI according to Glasgow Outcome Scale score, which is a measure of functional recovery and defined as severe disability, persistent vegetative state, and death.

Results

Overall, 79 patients with MTH (52.7% of the original trial) were examined; among these, unfavorable neurological outcomes were observed in 53.2%. Among all the groups, group (Admission HR ≥100 and %HR <?18.6) exhibited the highest proportion of unfavorable outcomes, and 82.3% of patients had an adjusted predicted probability of unfavorable outcomes, whereas those in group (Admission HR <?80 and %HR ≥?18.6) developed only 22.8% (p?=?0.04).

Conclusions

Mild HR decrease during the early phase of targeted temperature management following tachycardia at admission can be associated with unfavorable neurological outcomes after severe TBI.

     

Predictive factors for subsequent intrahepatic cholangiocarcinoma associated with hepatolithiasis: Japanese National Cohort Study for 18 years

Journal of Gastroenterology - Predictive factors for intrahepatic cholangiocarcinoma in long-term follow-up of hepatolithiasis are unknown. We thus conducted a cohort study to investigate the...     

Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study

Journal of Interventional Cardiac Electrophysiology - Clinical implication of local impedance (LI) for radiofrequency (RF) ablation has not been fully established. This study aimed to investigate...     

Kir6.2 is required for adaptation to stress

Reaction to stress requires feedback adaptation of cellular functions to secure a response without distress, but the molecular order of this process is only partially understood. Here, we report a previously unrecognized regulatory element in the general adaptation syndrome. Kir6.2, the ion-conducting subunit of the metabolically responsive ATP-sensitive potassium (K(ATP)) channel, was mandatory for optimal adaptation capacity under stress. Genetic deletion of Kir6.2 disrupted K(ATP) channel-dependent adjustment of membrane excitability and calcium handling, compromising the enhancement of cardiac performance driven by sympathetic stimulation, a key mediator of the adaptation response. In the absence of Kir6.2, vigorous sympathetic challenge caused arrhythmia and sudden death, preventable by calcium-channel blockade. Thus, this vital function identifies a physiological role for K(ATP) channels in the heart.     

Trends in age and anthropometric data at start of growth hormone treatment for girls with Turner syndrome in Japan

The purpose of this study is to evaluate the trends in age and anthropometric data for girls with Turner syndrome (TS) at start of growth hormone (GH) treatment in Japan. The data for analysis were obtained from a retrospective cohort, the Foundation for Growth Science, Japan. We analyzed trends in starting age of GH treatment for girls with TS in Japan after dividing subjects (n=1,478) into three registration periods: 1991-1994, 1995-1999 and 2000-2004. We also assessed the ratio of the subpopulation of subjects under five years of age. As results, the mean age (standard deviation (SD)) at start of GH treatment was significantly different among the three groups (10.95 (3.63), 10.15 (3.39) and 8.78 (3.61), p<0.0001). The proportion of the subjects under five years of age increased significantly over time (5.11%, 7.11% and 16.85%, p<0.0001). Mean (SD) height SD scores were also significantly different (-3.41 (0.87), -3.26 (0.81) and -3.17 (0.79), p<0.0001). However, the proportions of the karyotype of 45,X were not significantly different among the three groups (p=0.25). We concluded that age and shortness at initiation of GH treatment had been improving over time. However, these favorable trends have not fully met the conditions recommended by international clinical guidelines for TS.