Sialolithiasis in two areas of the upper lip

Objective

Minor salivary gland sialolithiasis occurs in ~1 % of all sialolithiasis cases. We report a case of sialolithiasis considered to have occurred in the minor salivary gland in two areas of the upper lip, with special emphasis on the findings from image examinations.

Case report

A 33-year-old male complained of a painless mass on the left upper lip. At the first examination, there was a nodular, hard swelling that involved the left cuspid area of the upper lip. Although a panoramic radiograph revealed no abnormality, an intraoral radiograph showed a small radiopaque body with a laminar pattern. Computed tomography images indicated that a calcified body was present in two areas of the upper lip. On magnetic resonance imaging, the lesion was observed as a lower-signal area than the surrounding soft tissue. The mass had a high signal in the central area in the T2 and short T1 inversion recovery images. The sonogram showed a hypoechoic mass with an echogenic structure in the central area. An excisional biopsy of the left upper lip was performed under local anesthesia. A well-demarcated mass with a calcified body was enucleated. The histopathologic diagnosis was sialoadenitis with sialolithiasis.

Conclusion

Most cases of minor salivary gland sialolithiasis are solitary, with multiple sialolithiasis being extremely rare. Sonograms are useful in the diagnosis of minor salivary gland sialolithiasis. Careful imaging examination is necessary to identify multiple lesions and select appropriate treatments.     

Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section

Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.     

Beta-lactamase stability of faropenem

Faropenem (FAR) is an orally available member of the penem class unique among carbapenems and other available beta-lactams. This study compared FAR to cephalosporins and imipenem with respect to beta-lactamase (BLA) stability and emergence of resistance to Staphylococcus aureus and Escherichia coli. BLA stability was studied using enzyme preparations from sonicated/centrifuged 24-hour cultures of E. coli, Enterobacter cloacae, Proteus vulgaris, Providencia rettgeri, Klebsiella pneumoniae, S. aureus, and Bacteroides fragilis grown in the presence of 20 mg/l ampicillin or cephaloridine to induce penicillinase or cephalosporinase, respectively. Substrate hydrolysis was quantitated spectrophotometrically. Multistep acquisition of resistance was promoted by growing bacteria in broth containing 2-fold dilutions of antibiotic over 10 cycles. Aliquots from test tubes with visible growth provided the inoculum for the next series of dilutions. FAR as well as other cephalosporins tested were highly stable to penicillinase derived from S. aureus and E. coli. However, E. coli- and P. vulgaris-derived cephalosporinase hydrolyzed cephaloridine, cefaclor and cefotiam considerably, whereas FAR was highly stable. FAR was highly stable against hydrolysis by various BLAs prepared from four B. fragilis strains and the rate of FAR hydrolysis by metallo-BLA was 5 times lower than that for imipenem. Additionally, the acquisition of resistant S. aureus strains was less pronounced for FAR compared to other agents tested. MICs rose 8-fold after the 10th sub-MIC exposure, while MICs rose 16-, 31- and 512-fold for cefixime, cefazolin and cefaclor, respectively. E. coli shifts in MICs were moderate for all the agents tested. In conclusion, FAR is characterized by pronounced BLA stability compared to other cephalosporins and imipenem. Furthermore, a lower propensity for resistance development with FAR as compared to cephalosporins was observed.     

Alterations of susceptibility of Pseudomonas aeruginosa by overproduction of multidrug efflux systems, MexAB-OprM, MexCD-OprJ, and MexXY/OprM to carbapenems: substrate specificities of the efflux systems

Overproduction of multidrug efflux systems MexAB-OprM, MexCD-OprJ, and MexXY/OprM of Pseudomonas aeruginosa caused reduction of susceptibility of the mutant, which lacked AmpC and all three systems to panipenem, meropenem, S4661 and DU6681a; meropenem, S4661 and DU6681a; and BO2727, panipenem, meropenem, S4661 and DU6681a, respectively, but not reduction of the susceptibility to imipenem and biapenem. Thus, we determined substrate specificities of these efflux systems to carbapenems. Received: February 28, 2002 / Accepted: July 5, 2002     

Foot pedal-activated injector for contrast-enhanced sonography

We assessed the feasibility and convenience of an injector that is electrically activated by a foot pedal for contrast-enhanced sonography. Thirty-seven patients with liver lesions underwent contrast-enhanced sonography using an injector that is activated by a foot pedal. The contrast agent was injected by pressing the foot pedal. All the studies were successfully performed without complications. The device enables the sonologist to keep the probe stationary during the injection and avoids the need for additional personnel. Pedal activated injection is a safe, useful, and convenient method of contrast-enhanced sonography.     

Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach

Background

Although several studies have been conducted on the patterns of recurrence in resected perihilar cholangiocarcinoma, they have many limitations. The aim of this study was to investigate recurrence after resection and to evaluate prognostic factors on the time to recurrence and recurrence-free survival.

Smooth muscle cells of human veins show an increased response to injury at valve sites

Objective

Venous valves are essential but are prone to injury, thrombosis, and fibrosis. We compared the behavior and gene expression of smooth muscle cells (SMCs) in the valve sinus vs nonvalve sites to elucidate biologic differences associated with vein valves.