A 40-year-old gossypiboma (foreign body granuloma) mimicking a malignant femoral surface tumor

The patient was a 61-year-old man who developed gossypiboma of the left thigh and femur resulting in the imaging appearances of a malignant surface tumor. He had a past history of surgery on the left femur for open fracture 40 years previously. Radiographs and CT showed a soft tissue mass with osteolysis and periosteal thickening of the left femur. On MRI, the mass showed heterogeneous signal intensity with contrast enhancement at the periphery, suggesting a malignancy. ^99mTc-HMDP bone scintigraphy showed a faint ring-like uptake, but thallium -201 scintigraphy did not show any uptake in the tumor. An extensive intralesional excision was performed. Postoperative histopathological examination showed a fibrous foreign body with reactive changes. There were neither viable cells nor atypical giant cells around the foreign body. No malignant change was evident. Based on surgical and histopathological examinations, the tumor was finally diagnosed as gossypiboma related to a retained surgical sponge.The patient was treated by Dr. Kenshi Sakayama at Ehime University Hospital, Ehime, Japan     

Clinical outcome after cardiac operations in patients with cirrhosis

BACKGROUND: To evaluate the clinical outcome after cardiac operations in patients with cirrhosis, a retrospective study was undertaken. METHODS: Between 1989 and 2003, 18 patients with cirrhosis who underwent cardiac operations were identified. Their preoperative status and postoperative clinical results were assessed. RESULTS: Ten patients were classified as having Child-Pugh class A cirrhosis, 7 as having class B cirrhosis, and 1 as having class C cirrhosis. Fifteen of 18 patients underwent cardiac surgery using cardiopulmonary bypass, and the remaining 3 patients with class B cirrhosis received coronary artery bypass grafting without cardiopulmonary bypass. In patients undergoing cardiopulmonary bypass, 60% of those with class A cirrhosis and 100% of those with class B cirrhosis and class C cirrhosis had postoperative major complications, including infection, respiratory failure, renal failure, bleeding, and gastrointestinal disorder. One of 3 patients (33%) with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass had major complications. The overall postoperative mortality rate was 17%. Hospital mortality of patients with class A cirrhosis, class B cirrhosis, and class C cirrhosis undergoing cardiopulmonary bypass was 0%, 50%, and 100%, respectively. None of 3 patients with class B cirrhosis undergoing coronary artery bypass grafting without cardiopulmonary bypass died in this study. CONCLUSIONS: Although the incidence of major complications was high, patients with Child-Pugh class A cirrhosis tolerated cardiac surgery satisfactorily. Patients with more advanced cirrhosis, however, may not be suitable for elective cardiac operations with cardiopulmonary bypass. Although our results are not conclusive, coronary artery bypass grafting without cardiopulmonary bypass can be an alternative therapeutic strategy for patients with advanced cirrhosis requiring surgical revascularization.     

Engineered FGF-2 expression induces glandular epithelial hyperplasia in the murine prostatic dorsal lobe

OBJECTIVE: It is known that androgens and stromal-epithelial interactions are required for the formation and growth of the prostate. FGF-2 is overexpressed in prostatic stromal cells in benign prostatic hypertrophy (BPH)/prostate cancer. This supports the paracrine/autocrine growth of prostatic epithelial/stromal cells in the pathogenesis of BPH and invasive prostate cancer. METHODS: We established transgenic mice expressing FGF-2 under the control of a short rat probasin promotor. FGF-2 transgenic founder mice expressing FGF-2 in the prostate were infertile. Thus, male founder mice were sacrificed for histological analysis. RESULTS: FGF-2 was expressed in epithelial cells in glands of the dorsal, lateral, and ventral prostatic lobes of two FGF-2 transgenic founder mice, but not in the anterior lobe of transgenic mice or in any lobe of non-transgenic control littermates. Acinar epithelial glands in dorsal prostatic lobes of FGF-2 transgenic mice expressing FGF-2 were more dense and showed simple papillary hyperplasia of epithelial cells compared with those of control littermate mice. Glandular and luminal enlargement without epithelial growth was observed in the ventral lobe of FGF-2 transgenic mice compared with the controls. CONCLUSION: In conclusion, FGF-2 transgenic mice under the control of rat probasin promoter showed simple epithelial hyperplasia in glands of the prostatic dorsal lobe and glandular enlargement without epithelial growth in the prostatic ventral lobe.     

N-cadherin plays a role in the synapse-like structures between mast cells and neurites

Communication between nerves and mast cells is a prototypic demonstration of neuro-immune interaction. Numerous studies have shown that the stimulation of nerves (or addition of neurotransmitters) can evoke activation of mast cells, and that mast cell-derived mediators can influence neuronal activity. However, the molecules involved in the membrane-membrane contacts between nerves and mast cells are still unknown. Here, we used an in vitro co-culture approach comprising interaction between immune (bone marrow-derived mast cell, BMMC) and nerve cells (superior cervical ganglia, SCG). The experiments showed clearly that the nerve-mast cell communication was supported by synapse-like structure and that N-cadherin, not E-cadherin, played an essential role in the synapse-like structure. In addition, we found that the synapse-like structure was assisted by clustering of beta-catenin to N-cadherin.     

Detection of neutrophils in late-onset interface inflammation associated with flap injury after laser in situ keratomileusis

OBJECTIVE: To report a case with late-onset interface inflammation associated with traumatic flap injury at 7 months after laser in situ keratomileusis (LASIK) and to describe the type of infiltrating cells in the tears of the patient. METHODS: Interventional case report. A 24-year-old male patient who underwent uneventful LASIK on both eyes received blunt trauma from the tip of a shoe in the left eye 7 months after surgery. The corneal flap of his left eye was lacerated across the pupillary area. Inflammatory cells were observed under the lacerated flap segment. Tear fluid was collected from his left eye 3 days after the injury and assessed by tear cytology. For controls, tears of 2 patients who underwent LASIK and developed no interface inflammation were collected the next day after their surgeries and examined. RESULTS: Tear fluid of the patient with interface inflammation contained numerous neutrophils. Tears of control patients contained only a few epithelial cells and cell debris but no inflammatory cells. The inflammation was decreased by systemic and topical steroids. However, irregular astigmatism caused by stromal scarring remained, resulting in decreased best-corrected visual acuity. CONCLUSIONS: Interface inflammation can be caused by late-onset flap injury. Neutrophils detected in the tears may reflect a major component of cells infiltrating the interface after LASIK.     

Guideline for diagnosis and therapy of osteoporosis from a point of view of sex difference

Osteoporosis occurs more common in women than that in men. In addition, there exist the sex differences in bone indexes such as bone mineral density (BMD), bone mineral content, and bone area or width, and in the decreased pattern of BMD associated with aging. Therefore, it is necessary to use a cut-off value of BMD of not women but men, as diagnostic criteria for male osteoporosis. In this article, from a point of view of sex difference, diagnosis and treatment of osteoporosis will be reviewed.     

Correlation between bone mineral density and intervertebral disk degeneration in pre- and postmenopausal women

 The purpose of this study was to investigate the relationship between intervertebral disk degeneration and bone mass. Magnetic resonance imaging was performed to evaluate lumbar disk degeneration according to Thompson's classification (grades 1 and 2, normal disk; grades 3, 4, and 5, degenerated disk), and bone mineral density (BMD) in the lumbar vertebrae, radius, and calcaneus was measured by dual-energy X-ray absorptiometry for 90 women (22–74 years old). The relationship between the grade of intervertebral disk degeneration and the BMD (Z score) was analyzed in pre- and postmenopausal women. In premenopausal women, BMD was significantly higher at all measured sites in the degenerated disk group judged at the L5–S1 level than in the normal disk group (P < 0.05). In postmenopausal women, BMD was significantly higher at the anteroposterior L2–L4, lateral L3, and calcaneus in the degenerated disk group judged at the L2–L3 level than in the normal disk group (P < 0.05). BMD at the anteroposterior L2–L4 and calcaneus was significantly higher in the degenerated disk group judged at the L3–L4 level than in the normal disk group (P < 0.05). In conclusion, the BMD of not only the lumbar vertebrae but also the calcaneus and radius was mutually related to lumbar intervertebral disk degeneration from an early stage of degeneration. Received: May 16, 2002 / Accepted: July 31, 2002 Offprint requests to: Y. Nanjo     

Application of human Fc epsilon RI alpha-chain-transfected RBL-2H3 cells for estimation of active serum IgE

We transfected the alpha-chain of human FcepsilonRI into rat basophilic leukemia cell line RBL-2H3, established several stable transfected cells, and screened them by beta-hexosaminidase release induced by sensitization with human IgE and stimulation with anti-human IgE antibody. A cloned cell line RBL-hEIa-2B12 was the strongest responder among the transfected cell clones. The concentrations of cytosolic free Ca2+ concentration in the human IgE-sensitized cells increased after stimulation with anti-human IgE antibody. Thus, it is suggested that the alpha-chain of human FcepsilonRI is associated with the beta-chain and/or gamma-chain of rat FcepsilonRI, and that they form functional high affinity IgE receptor complexes. The total IgE concentrations of the sera from allergic patients were determined by using the beta-hexosaminidase release assay, where the transfected cells were sensitized with diluted and heat-inactivated (at 56 degrees C for 30 min) serum and stimulated with anti-human IgE antibody. The IgE concentration obtained correlated with those measured by an enzyme immunoassay method. beta-Hexosaminidase release induced by stimulation with 5 times diluted serum was sometimes less than the release induced by the same serum; diluted 25 times or 125 times, suggesting that these serum contained factors that blocked IgE binding to FcepsilonRI or cross-linking by anti-human IgE antibody. The results suggested that our system will be useful for detecting FcepsilonRIalpha-bindable IgE in human serum.     

Effect of oxyethylene moieties in hydrogenated castor oil on the pharmacokinetics of menatetrenone incorporated in O/W lipid emulsions prepared with hydrogenated castor oil and soybean oil in rats

Lipid emulsions with particle sizes of 190-270 nm were prepared with soybean oil (SO) and a series of hydrogenated castor oils (HCOs) with various oxyethylene numbers, and the effect of oxyethylene numbers of HCOs on the pharmacokinetics of menatetrenone incorporated into the lipid emulsions was studied in rats. Plasma half-life of menatetrenone after administration as the lipid emulsions prepared by HCO with 10 oxyethylene units (SO/HCO10) was similar to that after the administration as SO/egg yolk phosphatides (SO/EYP), but was shorter than that as the lipid emulsions prepared by HCOs with > 20 oxyethylene units (SO/HCO20, SO/HCO30, SO/HCO60, SOHC and SO/HCO100). Menatetrenone incorporated in SO/HCO10, SO/HCO20 and SO/HCO60 was not taken up by the blood cells in vitro, and the plasma level of menatetrenone incorporated in SO/HCO10 was similar to that of triglycerides, suggesting that menatetrenone was not released from the oil particles even after entering the circulation. Menatetrenone uptake by the liver for SO/HCO10 was similar to that for SO/EYP, while those for SO/HCO20, SO/HCO30, SO/HCO60 and SO/HCO100 was less than that for SO/EYP. These findings clearly demonstrate that 20 oxyethylene units in HCOs is the minimum requirement for the prolongation of the plasma circulation time of menatetrenone incorporated in SO/HCOs.