Time-related changes in computed tomographic appearance and pathologic findings after radiofrequency ablation of the rabbit lung: preliminary experimental study

PURPOSE: To evaluate correlations between computed tomographic (CT) appearance and pathologic findings after radiofrequency (RF) ablation of lungs and to determine whether CT appearance could predict the extent of the effective therapeutic area. MATERIALS AND METHODS: The lungs of 14 rabbits were subjected to RF ablation and CT scans were obtained immediately and at various intervals thereafter. Four rabbits were killed immediately after the initial CT imaging (n = 4). The remaining 10 rabbits were killed after additional CT scans at intervals of 3 days (n = 2), 1 week (n = 4), 2 weeks (n = 2), and 3 weeks (n = 2) after RF ablation. Pathologic findings were correlated with CT appearance. RESULTS: Immediately after RF ablation, a restricted area of central dense opacity enclosed by an extensive area of ground-glass opacity was noted in the ablated region on CT images. Pathologically, the former corresponded to destructive tissue and the latter corresponded to tissue with some degree of injury. After 1 week, the entire ablated region appeared as a well-demarcated homogeneous dense opacity on CT that corresponded to necrotic tissue and its surrounding rim of granulation tissue on histopathologic examination, indicating that the enclosing extensive area of ground-glass opacity on the initial CT scan represented an ongoing necrosis. Within 2-3 weeks, the ablated region gradually contracted on the CT images, representing a tissue repairing process in which the granulation tissue was encroaching on the inner necrotic tissue. CONCLUSION: Ground-glass opacity of the ablated region on CT immediately after RF ablation represents an ongoing necrosis.     

Encrusted cystitis causing postrenal failure

Encrusted cystitis is characterized by chronic inflammation of the bladder with encrustation of the mucosa, induced by urea-splitting bacterial infection. However, encrusted cystitis in itself is not well known. We report a case of encrusted cystitis causing postrenal failure. An 81-year-old man with pneumonia complained of pollakisuria, micturition pain, and gross hematuria. Bladder calculi were found, and transurethral lithotripsy was performed. However, because his symptoms did not improve, he was referred to our hospital. His urine pH was 8.5, and urine culture grew Corynebacterium and Proteus. Computerized tomography and cystoscopy revealed bladder “encrustation,” caused by bladder wall calcification, and bilateral hydronephrosis. Hence, he was diagnosed with postrenal failure resulting from encrusted cystitis. Immediate bilateral nephrostomy was constructed, with continuous bladder perfusion with an acid solution for acidification of his urine, followed by intravenous administration of ceftriaxone. After 2 weeks of treatment, the calcification disappeared and his bladder mucosa was normalized. The postrenal failure also improved and thus the nephrostomy tubes were removed. Encrusted cystitis is curable by prompt treatment with acidification of urine. Therefore, precise diagnosis and therapy are critical.     

Metagenomic profile of gut microbiota in children during cholera and recovery

Background

The diverse bacterial communities colonizing the gut (gastrointestinal tract) of infants as commensal flora, which play an important role in nutrient absorption and determining the state of health, are known to alter due to diarrhea.

Method

Bacterial community dynamics in children suffering from cholera and during recovery period were examined in the present study by employing metagenomic tool, followed by DNA sequencing and analysis. For this, bacterial community DNA was extracted from fecal samples of nine clinically confirmed cholera children (age 2–3 years) at day 0 (acute cholera), day 2 (antibiotic therapy), day 7 and, and day 28, and the variable region of 16S rRNA genes were amplified by universal primer PCR.

Results

454 parallel sequencing of the amplified DNA followed by similarity search of the sequenced data against an rRNA database allowed us to identify V. cholerae, the cause of cholera, in all nine children at day 0, and as predominant species in six children, accounting for 35% of the total gut microbiota on an average in all the nine children. The relative abundance (mean ± sem %) of bacteria belonging to phyla Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria, was 55 ± 7, 18 ± 4, 13 ± 4, and 8 ± 4, respectively, at day 0, while these values were 12 ± 4, 43 ± 4, 33 ± 3, and 12 ± 2, respectively, at day 28. As antibiotic therapy began, V. cholerae count declined significantly (p< 0.001) and was found only in four children at day 2 and two children at day 7 with the relative abundance of 3.7% and 0.01%, respectively, which continued up to day 28 in the two children. Compared to acute cholera condition (day 0), the relative abundance of Escherichia coli, Enterococcus, and Veillonella increased at day 2 (antibiotic therapy) while Bifidobacterium, Bacteroides, and Ruminococcus decreased.

Conclusion

Cholera results expulsion of major commensal bacteria of phyla Bacteroidetes, Firmicutes, and Actinobacteria, and increase of harmful Proteobacteria to colonize the gut during acute and convalescence states. The observed microbiota disruption might explain the prevalent malnutrition in children of Bangladesh where diarrheal diseases are endemic.     

Hypothermic death: Possibility of diagnosis by post-mortem computed tomography

Referring to our experience with post-mortem computed tomography (CT), many hypothermic death cases presented a lack of increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and urine retention in the bladder. Thus we evaluated the diagnostic performance of post-mortem CT on hypothermic death based on the above-mentioned three findings. Twenty-four hypothermic death subjects and 53 non-hypothermic death subjects were examined. Two radiologists assessed the presence or lack of an increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and measured urine volume in the bladder. Pearson's chi-square test and Mann–Whitney U-test were used to assess the relationship between the three findings and hypothermic death. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the diagnosis were also calculated. Lack of an increase in lung-field concentration and blood clotting in the heart, thoracic aorta or pulmonary artery were significantly associated with hypothermic death (p = 0.0007, p < 0.0001, respectively). The hypothermic death cases had significantly more urine in the bladder than the non-hypothermic death cases (p = 0.0011). Regarding the diagnostic performance with all three findings, the sensitivity was 29.2% but the specificity was 100%. These three findings were more common in hypothermic death cases. Although the sensitivity was low, these findings will assist forensic physicians in diagnosing hypothermic death since the specificity was high.     

Dietary tin intake and association with canned food consumption in Japanese preschool children

Objectives

Dietary intake of tin has seldom been studied in children although they probably have a high intake. This study was initiated to investigate dietary tin intake (Sn-D) of children in Japan.

Methods

In this study, 24-h food duplicate samples were collected from 296 preschool children in Miyagi prefecture, Japan. Sn in the samples were analyzed by inductively coupled-plasma mass spectrometry, after homogenization and wet digestion.

Results

Sn-D by the children was low, with 4.2 μg/day as a median. The distribution was however wide, from 0.4 μg/day up to >3 μg/day. Canned foods were the major dietary Sn source, whereas rice contributed essentially little. Sn-D among canned food consumers was 30.2 μg/day as a geometric mean (10.6 μg/day as a median), whereas Sn-D among the non-consumers of canned foods was distributed log-normally, with 3.3 μg/day as a geometric mean (2.5 μg/day as a median). Sn levels in urine did not differ between children who consumed canned foods on the day previous to urine collection and those who did not. The Sn-D was far below the provisional tolerable weekly intake (14 mg/kg body weight/week) set by the 2001 Joint FAO/WHO Expert Committee. Nevertheless, children took more Sn than adults when compared on a body-weight basis.

Conclusions

Canned foods were the major source of dietary Sn intake for preschool children studied. Thus, median Sn-D was higher for the canned food consumers (10.6 μg/day) than for non-consumers of canned foods (2.5 μg/day). Sn-D by canned food-consuming children was, however, substantially lower than the provisional tolerable weekly intake. No difference was detected in Sn levels in urine between canned food-consuming and non-consuming children.     

Body awareness and mental health: a body psychotherapy case study

Dohsa-hou is a Japanese form of body psychotherapy that utilises body movement as a means of enhancing the psychotherapy process. Body awareness has recently been proposed as a potential contributor to therapeutic progress made in the course of body psychotherapy. This paper reports the utilisation of Dohsa-hou with a patient who had a history of outpatient and inpatient treatment for depression-related psychiatric symptoms. At the start of treatment, the patient had difficulty in releasing tension because of the harsh rigidity of her body; further, the patient did not know how to regulate tension. As the Dohsa-hou therapy progressed, the patient became aware of her tenseness and learned to self-regulate her bodily rigidity. Her severe depressive symptoms were alleviated along with the change in her physical rigidity. This study illustrates the process of the treatment and the contribution of body awareness to the therapeutic progress made.     

Association of XRCC1 polymorphisms with arsenic methylation

The associations of four single nucleotide polymorphisms (p.Arg194Trp, p.Arg280His, p.Pro206Pro, and p.Arg399Gln) in X-ray repair cross-complementing group 1 with urinary arsenic metabolites and 8-hydroxy-2′-deoxyguanosine (8-OHdG) were investigated in a Vietnamese population (n = 100). Individuals with genotype AA in p.Pro206Pro showed significantly higher urinary monomethylarsonic acid (MMA^V) and lower dimethylarsinic acid (DMA^V)/MMA^V ratio than genotype AG. As for p.Arg399Gln, both Arg/Arg homozygous subjects and Arg/Gln heterozygous individuals showed a significantly higher urinary inorganic As percentage and lower 8-OHdG concentrations than Gln/Gln homozygous. Our results suggested that Arg399Gln is a functional SNP that may be related to DNA repair activity.     

A case with chronic hepatitis C who developed liver cirrhosis due to liver dysfunction caused by pegylated interferon plus ribavirin treatment despite negativity of serum HCV RNA, during therapy

We report a case of chronic hepatitis C in whom liver cirrhosis was later diagnosed following abnormality of ALT levels during pegylated interferon α2a and ribavirin treatment. A 62-year-old woman with chronic hepatitis C was treated with pegylated interferon α2a plus ribavirin for 72 weeks. Her HCV RNA became negative 16 weeks after the start of treatment and continued to be negative for most of the treatment duration. Her AST/ALT, ALP/γ-GTP levels became elevated soon after the initiation of treatment and thereafter remained unchanged. However, most of these levels normalized after the end of treatment. Post-treatment liver biopsy showed liver cirrhosis, probably due to the interferon treatment itself. This unusual therapeutic outcome should be considered if the levels of hepatic dysfunction during interferon treatment are severe.