Acute renal failure due to adenovirus-associated obstructive uropathy and necrotizing tubulointerstitial nephritis in a bone marrow transplant recipient

Management of post-transplant complications caused by severe adenoviral infection remains a major therapeutic challenge. A 17-year-old male who had undergone bone marrow transplantation for the treatment of acute lymphoblastic leukemia developed complete anuria following hemorrhagic cystitis 34 days after the transplant procedure. The computed tomogram scan revealed bilateral hydronephrosis, indicating acute renal failure because of obstructive uropathy. The emergency procedure of percutaneous nephrostomy caused massive bleeding in the left kidney, which eventually required a nephrectomy. Adenovirus-positive severe necrotizing tubulointerstitial nephritis was the histopathological diagnosis. Post-transplant acute renal failure because of hydronephrosis, which could be complicated by adenovirus-induced renal parenchymal disease, is of great concern and may cause significant problems with interventional treatment.     

Joint biomarkers in idiopathic femoral head osteonecrosis: comparison with hip osteoarthritis

OBJECTIVE: To compare concentrations of joint biomarkers in synovial fluid (SF) between idiopathic osteonecrosis of the femoral head (ION) and osteoarthritis (OA) of the hip joint. METHODS: Levels of the joint biomarkers cartilage oligomeric matrix protein (COMP), antigenic keratan sulfate (AgKS), and hyaluronan (HA) in SF samples from 21 cases of ION and their relationship to disease stage and history of steroid use were assessed and compared to the result of 29 cases of hip OA. RESULTS: In both the ION and hip OA groups, levels of COMP and AgKS in SF showed a significant positive correlation. The ION group had significantly higher levels of AgKS in SF than the hip OA group. In the ION group, stage II patients had significantly higher SF levels of both COMP and AgKS than those in stage III patients. No difference in level of HA in hip joint SF was found between steroid and non-steroid treated ION patients or between the stage II and III subgroups. CONCLUSION: SF levels of COMP and AgKS may serve as useful joint biomarkers that reflect cartilage metabolism not only in hip OA but also in ION.     

Quantification of Pancreatic Stiffness on Intraoperative Ultrasound Elastography and Evaluation of its Relationship With Postoperative Pancreatic Fistula

“Soft pancreas” has often been reported as a predictive factor for postoperative pancreatic fistula (POPF) after pancreatectomy. However, pancreatic stiffness is judged subjectively by surgeons, without objective criteria. In the present study, pancreatic stiffness was quantified using intraoperative ultrasound elastography, and its relevance to POPF and histopathology was investigated. Forty-one patients (pancreatoduodenectomy, 30; distal pancreatectomy, 11) who underwent intraoperative elastography during pancreatectomy were included. The elastic ratio was determined at the pancreatic resection site (just above the portal vein) and at the remnant pancreas (head or tail). Correlations between the incidence of POPF and patient characteristics, operative variables, and the elastic ratio were examined. In addition, the relationship between the elastic ratio and the percentage of the exocrine gland at the resection stump was investigated. For pancreatoduodenectomy patients, main pancreatic duct diameter < 3.2 mm and elastic ratio < 2.09 were significant risk factors for POPF. In addition, the elastic ratio, but not main pancreatic duct diameter, was significantly associated with the percentage of exocrine gland area at the pancreatic resection stump. Pancreatic stiffness can be quantified using intraoperative elastography. Elastography can be used to diagnose “soft pancreas” and may thus be useful in predicting the occurrence of POPF.Key words: Elastography, Exocrine gland, Pancreatectomy, Pancreatic stiffness, Postoperative pancreatic fistulaDespite current advances in surgical techniques, pancreatectomy is a very difficult procedure associated with the risk of multiple postoperative complications. The morbidity and mortality are reported to be 20–50% and 1–5%, respectively.¹ In particular, a postoperative pancreatic fistula (POPF) can sometimes lead to life-threatening complications, such as hemoperitoneum and sepsis. The worldwide incidence of POPF is reported to be 5–50%. Several predictive factors for POPF have been reported to date, and, of these, “soft pancreas” has often been mentioned.^2–4 However, in all of these reports, evaluation of pancreatic stiffness has depended on subjective judgment by the surgeon, without objective parameters as criteria.Elastography has recently been developed to enable real-time visualization of the relative stiffness of tissue elasticity, and its usefulness in various clinical disciplines for tumor diagnosis and differential diagnosis has been described.⁵ In gastroenterology, evaluation of liver fibrosis and diagnosis of pancreatic tumors and chronic pancreatitis using endoscopic ultrasound (EUS) have been reported,^6,7 but the use of elastography in surgery has not been reported. An objective assessment of pancreatic stiffness as a predictive risk factor for POPF can help in choosing the intraoperative surgical technique and in planning the postoperative management strategy. Therefore, in the present study, pancreatic stiffness was quantified using intraoperative ultrasound elastography, and its relevance to POPF and histopathology was investigated.     

Serum albumin (SA) levels and 10-year mortality in a community-dwelling 70-year-old population

Although an association between SA concentrations and mortality in the patients is well known, this association is not conclusive in elderly community-dwelling populations. We therefore attempted to determine whether this association could be extended to a Japanese 70-year-old community-dwelling population. Seventy-year-old subjects residing in Niigata City, Japan participated. Baseline examinations including a determination of SA concentrations were performed in June 1998 in 600 participants, and they were followed for 10 years. During the 10-year follow up, 80 subjects died. Albumin levels were divided into four groups (highest > 45 g/l, higher 43-44 g/l, lower 41-42 g/l, lowest <40 g/l). The survival rate using Kaplan-Meier methods was longer in the highest and higher albumin groups than in the lowest and lower groups. No differences were found between the four groups in the mortalities from cancer, cardiovascular disease (CVD) or pneumonia. Individuals with the lowest albumin levels had 2.7 or 2.9 times higher total mortality, whether adjusted with confounding factors or not, using Cox regression analysis. The mortality hazard ratio (HR) found in the lowest group was compared to the highest group. In an elderly 70-year-old Japanese community-dwelling population, lower SA concentrations were an independent predictor of total mortality, but not mortality due to cancer, CVD, or pneumonia.     

Association Between Glucan Synthesis by Streptococcus mutans and Caries Incidence in Schoolchildren Receiving a Fluoride Mouth Rinse

Purpose: To determine whether variation in glucan synthesis by Streptococcus mutans isolates is associated with caries development in children receiving a fluoride mouth rinse (FMR). Materials and Methods: Of 122 children (aged 9 to 10 years), 64 had received FMR (FMR(+) group) and the remaining 58 children had not (FMR(-) group). The number of decayed and filled teeth (DFT) and increases in the number of DFT in 1 year (dDFT) were recorded. Saliva samples were collected to isolate the clinical S. mutans strains. The isolates were incubated in heart infusion broth supplemented with 1% sucrose, then the amount of water-insoluble glucan (WIG) formed on a glass tube surface was evaluated. Results: In the FMR(-) group, children carrying S. mutans had a higher DFT (P = 0.039) and tended to have a higher dDFT (P = 0.080) than the others. In the FMR(+) group, although the differences between children with and without S. mutans were not significant, children carrying S. mutans that produced a high amount of WIG had higher dDFT than the other S. mutans-positive children (P = 0.034). Conclusions: This study revealed that the variation in glucan synthesis by S. mutans is associated with caries development in children receiving a FMR.