Arthroplasty of the interphalangeal joint of the great toe using costal osteochondral grafting

Although many reports have been published on the usefulness of costal cartilage grafting in the reconstruction of interphalangeal joints of fingers, there are only a few published reports on the reconstruction of interphalangeal joints of toes. We describe a 21-year-old woman with a tissue defect of the dorsum pedis and a partial defect of the interphalangeal joint of the great toe caused by a motor-vehicle accident. We attempted arthroplasty using a free latissimus dorsi myocutaneous flap and a costal osteochondral graft. The grafted rib and cartilage survived, allowing the patient to resume functional ambulation for day-to-day activities. Arthroplasty using costal osteochondral grafts seems to be an effective means of reconstructing the interphalangeal joints of toes.     

International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality

Existing national, racial, and ethnic differences in dialysis patient mortality rates largely are unexplained. This study aimed to test the hypothesis that mortality rates related to atherosclerotic cardiovascular disease (ASCVD) in dialysis populations (DP) and in the background general populations (GP) are correlated. In a cross-sectional, multinational study, all-cause and ASCVD mortality rates were compared between GP and DP using the most recent data from the World Health Organization mortality database (67 countries; 1,571,852,000 population) and from national renal registries (26 countries; 623,900 population). Across GP of 67 countries (14,082,146 deaths), all-cause mortality rates (median 8.88 per 1000 population; range 1.93 to 15.40) were strongly related to ASCVD mortality rates (median 3.21; range 0.53 to 8.69), with Eastern European countries clustering in the upper and Southeast and East Asian countries in the lower rate ranges. Across DP (103,432 deaths), mortality rates from all causes (median 166.20; range 54.47 to 268.80) and from ASCVD (median 63.39 per 1000 population; range 21.52 to 162.40) were higher and strongly correlated. ASCVD mortality rates in DP and in the GP were significantly correlated; the relationship became even stronger after adjustment for age (R(2) = 0.56, P < 0.0001). A substantial portion of the variability in mortality rates that were observed across DP worldwide is attributable to the variability in background ASCVD mortality rates in the respective GP. Genetic and environmental factors may underlie these differences.     

Effect of therapeutic moderate hypothermia on multi-drug resistance protein 1-mediated transepithelial transport of drugs

To clarify the effect of therapeutic moderate hypothermia on drug distribution, transepithelial transport via multi-drug resistance protein 1 (MDR1) (also called P-glycoprotein or ABCB1) was evaluated at various temperatures in vitro using LLC-GA5-COL150 cells, which were established by transfecting human MDR1 complementary deoxyribonucleic acid into kidney epithelial LLC-PK(1) cells and express MDR1 on the apical membrane. MDR1 is expressed in the blood-brain barrier to limit drug distribution to the brain by exporting exogenous substances including calcium blockers and antiarrhythmic drugs. Digoxin was used as a typical substrate, as well as the non-substrate tetracycline and paracellular marker inulin. MDR1-mediated transport of digoxin decreased at lower temperatures. Transport of tetracycline also decreased at lower temperatures, probably due to changes in membrane fluidity. However, no change was found at over 32 degrees C, suggesting that passive diffusion does not change during moderate hypothermia. The distribution of MDR1 substrates should be considered during hypothermic conditions, as the clinical outcome could be affected.     

Radiofrequency-assisted partial splenectomy with a new and simple device

BACKGROUND: Although partial splenectomy is preferable to total splenectomy for maintaining an immune response, several techniques by which splenic parenchyma were divided in partial splenectomy have been controversial. METHODS: Partial splenectomy using a new and simple device that irradiates radiofrequency combined with saline irrigation was performed successfully for a 19-year-old man with a large splenic cyst. Splenic parenchyma coagulated along the cutting line by the device was divided using an ultrasonic dissector. RESULTS: The surgical field was virtually bloodless during the parenchymal transection. Blood loss during the surgery was 50 mL without transfusion and the other hemostatic procedures and transection time was 10 minutes. The patient's postoperative course was uneventful and he was discharged home with a perfused spleen on postcontrast computed tomography. CONCLUSIONS: The radiofrequency-assisted technique allows partial splenectomy as a safe and virtually bloodless alternative to total splenectomy for selected patients.     

Isoflurane produces sustained cardiac protection after ischemia-reperfusion injury in mice

BACKGROUND: Isoflurane reduces myocardial ischemia-reperfusion injury within hours to days of reperfusion. Whether isoflurane produces sustained cardiac protection has never been examined. The authors studied isoflurane-induced cardiac protection in the intact mouse after 2 h and 2 weeks of reperfusion and determined the dependence of this protection on adenosine triphosphate-dependent potassium channels and the relevance of this protection to myocardial function and apoptosis. METHODS: Mice were randomly assigned to receive oxygen or isoflurane for 30 min with 15 min of washout. Some mice received mitochondrial (5-hydroxydecanoic acid) or sarcolemmal (HMR-1098) adenosine triphosphate-dependent potassium channel blockers with or without isoflurane. Mice were then subjected to a 30-min coronary artery occlusion followed by 2 h or 2 weeks of reperfusion. Infarct size was determined at 2 h and 2 weeks of reperfusion. Cardiac function and apoptosis were determined 2 weeks after reperfusion. RESULTS: Isoflurane did not change hemodynamics. Isoflurane reduced infarct size after reperfusion when compared with the control groups (27.7 +/- 6.3 vs. 41.7 +/- 6.4% at 2 h and 19.6 +/- 5.9 vs. 28.8 +/- 9.0% at 2 weeks). Previous administration of 5-hydroxydecanoic acid, but not HMR-1098, abolished isoflurane-induced cardiac protection. At 2 weeks, left ventricular end-diastolic diameter was decreased significantly and end-systolic pressure and maximum and minimum dP/dt were improved by isoflurane. Isoflurane-treated mice subjected to ischemia and 2 weeks of reperfusion showed less expression of proapoptotic genes, significantly decreased expression of cleaved caspase-3, and significantly decreased deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling-positive nuclei compared with the control group. CONCLUSIONS: Cardiac protection induced by isoflurane against necrotic and apoptotic cell death is associated with an acute memory period that is sustained and functionally relevant 2 weeks after ischemia-reperfusion injury in mice in vivo.     

Phylogenetic, ontogenetic, and pathological aspects of the urine-concentrating mechanism

The urine-concentrating mechanism is one of the most fundamental functions of avian and mammalian kidneys. This particular function of the kidneys developed as a system to accumulate NaCl in birds and as a system to accumulate NaCl and urea in mammals. Based on phylogenetic evidence, the mammalian urine-concentrating mechanism may have evolved as a modification of the renal medulla's NaCl accumulating system that is observed in birds. This qualitative conversion of the urine-concentrating mechanism in the mammalian inner medulla of the kidneys may occur during the neonatal period. Human kidneys have several suboptimal features caused by the neonatal conversion of the urine-concentrating mechanism. The urine-concentrating mechanism is composed of various functional molecules, including water channels, solute transporters, and vasopressin receptors. Abnormalities in water channels aquaporin (AQP)1 and AQP2, as well as in the vasopressin receptor V2R, are known to cause nephrogenic diabetes insipidus. An analysis of the pathological mechanism involved in nephrogenic diabetes insipidus suggests that molecular chaperones may improve the intracellular trafficking of AQP2 and V2R, and, in the near future, such chaperones may become a new clinical tool for treating nephrogenic diabetes insipidus.     

A gastric fibrolipoma presenting as acute gastrointestinal hemorrhage

A 56-year-old woman was admitted to our hospital with upper gastrointestinal hemorrhage from a gastric submucosal tumor that was treated by a laparoscopic technique. Endoscopy and endoscopic ultrasonography (EUS) revealed a 2-cm submucosal tumor located in the posterior wall of the upper gastric body, showing a heterogeneous hyperechoic tumor. A laparoscopic wedge resection of the stomach was performed. Pathological examinations revealed that the tumor was composed of spindle cells like fibroblasts and mature adipocytes. Immunohistochemical examinations revealed that the tumor was negative for desmin and alpha-smooth muscle actin. Based on these findings, a diagnosis of fibrolipoma was made. EUS is useful for differentiating a fibrolipoma from a gastrointestinal stromal tumor or lipoma by the findings of characteristic echogenesity and detection of the tumor origin.     

Xanthogranulomatous pyelonephritis presenting a subcutaneous mass in the lower abdomen: a case report

A 72-year-old female presented with the complaint of left lower abdominal swelling in May, 2005. Laboratory analysis revealed elevated white blood cell counts and C-reactive protein. Abdominal computed tomography showed left ureteral calculi, left hydronephrosis and a mass extending through the perinephric space, psoas major muscle into the left flank and lower abdomen. Echo-guided needle mass biopsy was performed. Histopathological findings revealed xanthogranulomatous changes. Under the diagnosis of diffuse xanthogranulomatous pyelonephritis extended into psoas muscle and subcutaneous tissue, antibiotic therapy was given for 5 months. After reduction of subcutaneous mass, left nephroureterectomy was performed. Histopathological findings revealed xanthogranulomatous pyelonephritis and ureteritis. Postoperative course was uneventful without any relapse of inflammation.