Mesenteric cyst: sonographic findings

Background: Mesenteric cyst (MC) is a relatively rare disease, and its sonographic characteristics have not been sufficiently analyzed. Methods: We studied the sonographic findings of eight patients with MC, with attention paid to its size, shape, internal echoes, and especially the presence or absence of lateral shadowing and the mode of back echoes. In four cases, the sound velocity and acoustic impedance of cystic fluid were also measured. The mode of blood flow was evaluated by color Doppler sonography. Results: Six cases showed an oval or comma-shaped mass. Internal echoes were present in six cases, and two of them showed a pseudosolid pattern. In these cases, M-mode sonography confirmed the movement of these internal echoes. Only one case showed a posterior echo enhancement, and no case showed lateral shadowing. Sound velocity measured in four cases was 1515–1537 m/s, with an acoustic impedance of 1.550–1.576 kg/m²/s. No blood flow signals were obtained from the lesion. Conclusion: MC exhibits so many patterns on ultrasound that we should consider the possibility of MC when encountering an avascular oval mesenteric mass. Received: 30 August 1999/Accepted: 6 October 1999     

Laparoscopic Nephrectomy,Ex Vivo Repair,and Autotransplantation for a Renal Artery Aneurysm: Report of a Case

A 57-year-old woman was hospitalized with a left renal artery aneurysm (RAA). The aneurysm measured 35 mm in diameter and was located at the renal artery bifurcation. We performed a laparoscopic nephrectomy using a retroperitoneal approach and performed an ex vivo repair of the renal artery. The reconstructed kidney was then autotransplanted at the left iliac fossa. The patient's postoperative course was uneventful. A laparoscopic nephrectomy and ex vivo repair are both considered to be effective for treating complex RAA.     

Loss of claudin-1 expression correlates with malignancy of hepatocellular carcinoma

BACKGROUND: The prognosis for the hepatocellular carcinoma (HCC) patient is affected by invasion and metastases. The attenuated expression of adherens junction protein epithelial-cadherin (E-cad) correlates with a more malignant potential in HCC. However, the potential of the claudin (CL) family of tight junctional proteins for HCC prognosis has remained unrecognized. MATERIALS AND METHODS: We immunohistochemically examined the expression of CL-1 and E-cad in resected specimens from 55 HCC cases. The percentage of CL-1- or E-cad-positive cells was counted in HCC cells and the surrounding hepatocytes and scored as 0 (0%), 1 (1-33%), 2 (34-66%), and 3 (67-100%). The expression of CL-1 or E-cad was considered "preserved" if the score in HCC was equal to or more than that in the surrounding hepatocytes, and "attenuated" if not so. RESULTS: In nontumorous tissue, CL-1 and E-cad were observed at the lateral surface of hepatocytes and biliary epithelial cells. In well-differentiated HCCs, the expression of CL-1 and E-cad was preserved in 12 of 14 cases. In poorly differentiated HCCs, E-cad expression was preserved in 9 of 18 cases, while CL-1 expression was preserved in only 4 cases (P<0.01 versus well-differentiated HCCs). HCCs with portal invasion showed significantly attenuated CL-1 expression than those without portal invasion (P<0.05). The survival rate after hepatectomy for HCC with attenuated CL-1 expression was significantly lower than that for HCC with preserved CL-1 expression. CONCLUSIONS: Attenuated expression of CL-1 closely correlates with the dedifferentiation and portal invasion of HCC. Down-regulated CL-1 expression may serve as a potential marker for a poor prognosis in HCC.     

The relationship between the number of the autonomic nerve receptors and degree of hyperreactive nasal symptoms in patients with hyperesthetic rhinitis

It is generally accepted that abnormal autonomic responsiveness may contribute to the pathogenesis of hyperesthetic rhinitis. Histologically, in the nasal mucosa, cholinergic fibers are found close to blood vessels, but are particularly numerous around the glands. Adrenergic fibers are found mainly around the vascular structures. Physiological and pharmacological studies demonstrate that parasympathetic hypersensitivity causes hypersecretion, and sympathetic hyposensitivity causes vasodilatation. alpha 1-adrenergic receptor function is dominant for this vasodilatation. Using radioligand binding techniques, it has been found that there is an increased number of muscarinic cholinergic receptors and a decreased number of alpha 1- and beta-adrenergic receptors in patients with nasal allergy, while the binding affinities do not change. In this report, using radioligand binding techniques, we investigated the relationships between the number of receptors and the degree of the hyperreactive nasal symptoms in patients with hyperesthetic rhinitis. The results are as follows. 1. The number of muscarinic cholinergic receptors of human nasal mucosa in patients with hyperesthetic rhinitis was related significantly (P less than 0.01) to the degree of hypersecretion induced by methacholine and frequency of blowing nose estimated from allergy diary. 2. There was no relationship between frequency of sneezing and the number of muscarinic cholinergic receptors. 3. The number of alpha 1-adrenergic receptors was related significantly (P less than 0.05) to the degree of swelling of nasal mucosa induced by methoxyamine. Judging from these results, it was assumed that pathogenesis of hyperreactive nasal symptoms may be associated at least partially to the changes of number of autonomic nerve receptors in the nasal mucosa.     

Successful transplantation of soy bean agglutinin-fractionated,histoincompatible, maternal marrow in a patient with severe combined immunodeficiency and BCG infection

A successful transplantation of soybean agglutinin (SBA) and sheep red blood cell (SRBC)-fractionated, maternal marrow in a patient with severe combined immunodeficiency (SCID) is reported. The engraftment of HLA-haplotype mismatched marrow cells was obtained without apparent graft versus host disease (GVHD). With immunological reconstituion the patient recovered from a BCG infection, which might have been caused by a BCG inoculation before his bone marrow transplantation.Abbreviations SCID severe combined immunodeficiency - PPD purimed protein derivative - SK-SD streptokinase/streptodornase - MLC mixed leukocyte culture - SBA soybean agglutinin - SRBC (E) sheep red blood cell - GVHD graft versus host disease - PHA phytohaemagglutinin - Con A concanavalin A - PWM pokeweed mitogen - EBV Epstein-Barr virus - cpm counts per min     

Effect of long-term use of reserpine, a sympathetic neuron blocker, on muscarinic cholinergic receptors in the guinea pig nasal mucosa

To evaluate whether hypofunction of the sympathetic nervous system induced by long-term reserpine treatment affects the parasympathetic system in the nasal mucosa in the receptor level, a receptor binding assay was performed using the nasal mucosa of guinea pigs which had chemical denervation produced by intraperitoneal injection of 0.1 mg/body reserpine once daily for 4 weeks. The maximum number of muscarinic cholinergic receptor bindings to diquinuclidinyl benzilate (3H-QNB) in the nasal mucosa of the reserpine-treated guinea pigs was increased by 46% as compared with that in the control (p less than 0.05). The present experiment shows that hypofunction of the sympathetic system in the nasal mucosa induced by reserpine may affect the parasympathetic system in the nasal mucosa.     

Two novel mutations of thiazide-sensitive Na-Cl cotrans porter (TSC) gene in two sporadic Japanese patients with Gitelman syndrome

Gitelman syndrome is a renal disorder characterized by hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria due to the defective tubular reabsorption of magnesium and potassium. This disease is caused by mutations of thiazide-sensitive Na-Cl cotransporter (TSC) gene. Gitelman syndrome is usually distinguished from Bartter syndrome by the presence of both hypomagnesemia and hypocalciuria. However, a phenotypic overlap is sometimes observed. We encountered two sporadic Japanese patients with Gitelman syndrome and analyzed their TSC gene. These patients were diagnosed as Gitelman syndrome by the typical clinical findings and biochemical abnormalities, such as mild muscular weakness, periodic paralysis, tetany, metabolic alkalosis, hypomagnesemia and hypocalciuria. In patient 1, a novel two base deletion (del TG at nucleotide 731 and 732) in exon 5 and a two base deletion (del TT at nucleotide 2543 and 2544) in exon 21 previously reported in a Japanese patient were identified. The patient 2 had a missense mutation (L623P), that was also identified in Japanese patients, and a novel in-frame 18 base insertion in exon 6 as a heterozygous state. Family analysis of two patients confirmed an autosomal recessive inheritance. In conclusion, we add two new mutations of the TSC gene in Japanese patients with Gitelman syndrome. Because the differential diagnosis between Bartter syndrome and Gitelman syndrome is sometimes difficult, molecular analysis would be a useful diagnostic tool, particularly in unusual cases with phenotypic overlapping.