Conservative treatment of ruptured vertebrobasilar dissecting aneurysm

Ruptured vertebrobasilar dissecting aneurysm is usually treated surgically because rebleeding negatively affects outcome. However, the risk of rebleeding decreases markedly once several hours have passed from the initial bleeding. Moreover, surgery-related complications are not rare. We describe seven patients with ruptured vertebrobasilar dissecting aneurysm. To prevent rebleeding during the acute stage, we treated all seven patients conservatively with fentanyl instead of emergency surgery. During the follow-up period (mean 20 months), no patient suffered rebleeding. Conservative treatment with fentanyl administration may be a good option for management of ruptured vertebrobasilar dissecting aneurysm during the acute stage.     

Herpes Simplex Encephalitis: A light and electron microscopic study in a fatal case

A fatal case was described of a 41–year-old woman with a tentative clinical diagnosis of acute viral meningoencephalitis of nine days' duration. The neuropathologic findings by light microscopy resembled those of acute necrotizing encephalitis or herpes simplex encephalitis, including eosinophilic intranuclear inclusion bodies of Cowdry type A. Electron microscopic study of these inclusions demonstrated the presence of herpes-type virus particles. Though the titer of herpes simplex virus examined on the sixth day of the illness was not elevated and the isolation of the virus was not successful, the case was regarded as herpes simplex encephalitis clinicopatholo-gically.     

Controlled tubulogenesis from dispersed ureteric bud‐derived cells using a micropatterned gel

Developmental engineering is a potential option for neo‐organogenesis of complex organs such as the kidney. The application of this principle requires the ability to construct a tubular structure from dispersed renal progenitor cells with defined size and geometry. In this present study we report the generation of tubular structures from dispersed ureteric bud cells in vitro by using a micropatterned gel. Dispersed CMUB‐1 cells, a mouse ureteric bud‐derived cell line, or mIMCD cells, a mouse collecting duct‐derived cell line, were suspended in collagen I and seeded into an agarose‐based micropatterned gel. We found that within 24–36 h of incubation, the cells developed a tubular structure that conformed to the geometry of the micropattern of the gel. The lumen formation of the tubular structure was confirmed by immunohistochemical staining and observed by confocal microscopy. We found that higher concentrations of collagen I negatively influenced the efficiency of tubular formation. Tubule formation in CMUB‐1, but not mIMCD, cells was positively influenced by the addition of aldosterone (10, 50 and 200 µg/ml), FGF (50 and 100 µg/ml) and fibronectin (10 and 50 µg/ml) to the growth medium. We further demonstrated the functionality of the generated tubes by in vitro budding, which was induced by growth factors, such as glial cell‐derived neurotrophic factor (GDNF) or fibroblast growth factor 7 (FGF7), in the presence of beads soaked with the activin A inhibitor follistatin. Our current study thus demonstrates the possibility of constructing a functional tubular structure from dispersed ureteric bud cells in vitro in a controlled manner. Copyright © 2014 John Wiley & Sons, Ltd.     

<Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection,but not genetic polymorphism of CYP2E1, is highly prevalent in gastric cancer patients younger than 40 years

Background Gastric cancers in young adults are thought to be associated with risk factors that include Helicobacter pylori infection and genetic polymorphism. The objective of this study was to elucidate the roles of these risk factors in patients younger than 40 years by analyzing clinicopathological data and H. pylori infection, and using molecular epidemiologic techniques. Methods Clinicopathological features, the presence of H. pylori infection, endoscopic characteristics of gastritis, genetic polymorphism of P4502E1 (CYP2E1), and family history of cancer in patients with gastric cancer treated surgically at Nippon Medical School Hospital from 1991 to 2004 were analyzed, based on our medical database. Results Gastric cancer in those younger than 40 years was characterized by a predominance of female patients with poorly differentiated adenocarcinoma who had undergone total gastrectomy with extended lymphadenectomy. H. pylori infection had a higher prevalence in patients with gastric cancer than in patients with normal endoscopic results or chronic gastritis, especially in those younger than 40 years (odds ratio, 13.7). Atrophic gastritis, nodular gastritis, and rugal hyperplastic gastritis were observed by endoscopy as H. pylori-associated gastritis. No difference in the incidence of either CYP2E1 genetic polymorphism or a family history of cancer was observed among different age groups. Conclusion Gastric cancer in patients younger than 40 years is closely associated with H. pylori infection, but not with genetic characteristics. Eradication therapy for H. pylori and endoscopic examination of H. pylori-positive young adults may be anticipated to be adopted as a strategy for the prevention and/or early detection of cancer.     

Two cases of methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> keratitis after Epi-LASIK

Background  We describe two severe cases of methicillin-resistant Staphylococcus aureus (MRSA) keratitis following Epi-LASIK surgery. Cases  One patient was a 23-year-old man who underwent Epi-LASIK surgery in both eyes. He developed an infectious corneal ulcer in one eye 2 days after surgery and was referred to us 7 days post-surgery with corneal perforation, for which we performed therapeutic penetrating keratoplasty. The other patient was a 32-year-old man who developed infectious keratitis in one eye 4 days after bilateral Epi-LASIK and was referred to us 2 days later. Observations  Microbial testing revealed MRSA infection as the cause of the keratitis in both patients which was successfully treated with vancomycin eyedrops. Conclusion  Infectious keratitis after refractive surgery is uncommon; it is important to diagnose this condition, identify the causative agent, and initiate treatment with appropriate antibiotics as soon as possible.     

The influence of cardiovascular malformations on the prognosis of esophageal atresia and distal tracheoesophageal fistula

Two hundred and seventy-six cases of esophageal atresia (EA) and tracheoesophageal fistula (TEF) (173 males and 103 females) were studied. A cardiovascular malformation (CVM) was the most common associated anomaly (79 cases, 32%). The most common extracardiac malformations (ECM) included skeletal, gastrointestinal, and urinary tract anomalies. There was a significantly lower mortality in patients without associated anomalies (5%) compared to those with a major CVM (41%) (P<.01) but not compared to those with a minor CVM (10%). No significant difference in survival could be attributed to the specific types of CVM, although the overall survival in those with a non-complex CVM (64%) was higher than in those with a complex CVM (12%). It was not possible to associate a particular ECM with a specific form of CVM, but the greater the number of ECMs present, the greater the likelihood of associated CVM. Offprint requests to: S. H. Ein     

Analysis of Breathing Pattern in Children with Asthma

The breathing pattern in children with asthma was studied, using respiratory inductive plethysmography. The subjects were 31 children with mild to moderate asthma (15 males, 16 females; aged 6∼15 years, average 11 years). The respiratory rate was 25.5±10.7/min. (mean ± S.D.) during asthma attacks and 18.4 ± 5.0/min. between attacks with a significant increase during attacks (P < 0.001). The expiratory time was 1.774 ± 0.833 second during attacks, and 2.125 ± 0.602 seconds between attacks. The expiratory time to total respiratory time ratio (T_E/T_TOT) was 0.631 ± 0.056 during attacks and 0.608 ± 0.035 between attacks. Thus there was a slight prolongation at the time of attack, but the difference was not significant. The tidal volume was increased slightly during mild and moderate attacks. V_T/T_I (mean inspiratory flow) was increased during attacks. The respiratory pattern was thoracic during attacks and changed to the abdominal pattern with improvement.     

Enema reduction of intussusception with a small dose of iopamidol may have advantages over barium

Barium enema (B-enema) has been the standard method for hydrostatic reduction of intussusception, although recently air enema has been used due to the lower risk when perforation occurs. Recently, we have administered a small dose of iopamidol during enema reduction (I-enema) in children with intussusception. From November 1989 to December 1993, we treated 50 children with intussusception at Kiyama Hospital. Barium was used in the first half of the period, and iopamidol in the second half. Reduction was successful in 22 of 24 patients with barium (92%) and 23 of 26 with iopamidol (88%); 25 children had the ileocolic type and 25 the ileoileocolic (-cecal) type of intussusception. Operations were carried out in 3 patients from each group. I-enema avoids some of the drawbacks of barium and air enemas. It is a new method of enema reduction, as a contrast medium is injected first. It is possible to obtain a good image of the advanced portion with a small dose of contrast medium, which is important for treatment. For institutions performing B-enemas, I-enemas can be performed easily with the same equipment and technique. It causes less contamination upon leakage than a B-enema, and also has less influence on the intestinal membrane with very few risks if perforation occurs. Better images are obtained than with air. A large dose of contrast medium is not needed, thereby reducing medical expenses to a minimum. Iopamidol can be used safely for enema reduction of intussusception with an expected high success rate.     

Cell-cycle-dependent invasion in vitro by rat ascites hepatoma cells

The relationship between cell cycle and experimental metastasis of tumor cells in vivo has been investigated, but it remains to be elucidated which step of metastasis, or whether tumor-cell invasion in particular, depends on cell cycle. We previously reported an in vitro cell-monolayer invasion (transcellular migration) assay system, in which the invasive capacity of tumor cells is measured by counting tumor cells penetrating beneath a cultured mesothelial cell monolayer after tumor-cell seeding. Using our invasion assay system, the relationship between invasive capacity and cell-cycle distribution of MMI cells, a highly invasive clone of rat ascites hepatoma AH130, was investigated. Invasive capacity of aphidicolin- or hydroxyurea-synchronized tumor cells enriched in G₁/S—early S-phase cells was about 2 to 6 times higher than that of asynchronous cells. According to time-course experiments to examine the relationship between invasive capacity and the size of fraction of cells in each phase after release from an aphidicolin or a nocodazole block, it was suggested that MMI cells are most invasive in G₁/S-S phase. Phagokinetic assay using colloidal gold particles showed that one possible reason for the enhanced invasiveness might be the increased cell motility in such phases, as suggested by the in vitro invasion assay.