Renal Arcuate Vein Microthrombi-Associated AKI

Backgrounds and objectives

This report describes six patients with AKI stages 2–3 (median admission creatinine level, 2.75 mg/dl [range, 1.58–5.44 mg/dl]), hematuria (five with hemoproteinuria), and unremarkable imaging with an unusual and unexplained histologic diagnosis on renal biopsy.

Design, setting, participants, & measurements

The patients were young adults who presented to two neighboring United Kingdom nephrology centers over a 40-month period (between July 2010 and November 2013). Four were male, and the median age was 22.5 years (range, 18–27 years). Their principal symptoms were flank pain or lower back pain. All had consumed alcohol in the days leading up to admission.

Results

Renal biopsy demonstrated microthrombi in the renal arcuate veins with a corresponding stereotypical, localized inflammatory infiltrate at the corticomedullary junction. All patients recovered to baseline renal function with supportive care (median, 17 days; range, 6–60 days), and none required RRT. To date, additional investigations have not revealed an underlying cause for these histopathologic changes. Investigations have included screening for thrombophilic tendencies, renal vein Doppler ultrasonographic studies, and testing for recreational drugs and alcohol (including liquid chromatography–mass spectrometry of urine) to look for so-called designer drugs. Inquiries to the United Kingdom National Poisons Information Centre have identified no other cases with similar presentation or histologic findings.

Conclusions

Increased awareness and additional study of future cases may lead to a greater understanding of the underlying pathophysiologic mechanisms that caused AKI in these patients.     

Detection of mesenteric ischemia by means of endoscopic visible light spectroscopy after luminal feeding

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Laparoscopic management of the median arcuate ligament syndrome

Background: The median arcuate ligament syndrome (MALS) is an infrequent cause of abdominal pain. This diagnosis is made after exclusion of other more common causes of upper abdominal symptoms. Mesenteric duplex and a computerized tomography mesenteric angiography demonstrate dynamic compression of the coeliac axis during expiration. Methods: Retrospective analysis of presenting symptoms, preoperative findings and postoperative outcomes. Results: Five consecutive patients who underwent laparoscopic division of the median arcuate ligament over a 4‐year period (2006–2010) are presented. This procedure was associated with low morbidity and complete relief of symptoms in all patients. Conclusion: A minimally invasive procedure is the treatment of choice in selected patients with MALS.     

Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus

Celiac axis stenosis is frequently associated with pancreaticoduodenal artery aneurysms. Although the cause of stenosis was not clear in most of the reported cases, compression of the median arcuate ligament of the diaphragm was found to be responsible for the stenosis in 7 of 42 reported cases of this type of aneurysm. We report a case of aneurysm caused by compression of the median arcuate ligament of the diaphragm and celiac plexus. An asymptomatic 43-year-old Japanese man was admitted with a low echoic lesion in the uncus of pancreas. Computed tomographic scan and angiogram revealed stenosis of the celiac axis and two aneurysms in the inferior posterior pancreaticoduodenal artery. The celiac plexus and median arcuate ligament were divided surgically and normal flow was reestablished in the celiac axis. One of the aneurysms was resected and the afferent artery of the other aneurysm was ligated. In the setting of pancreaticoduodenal artery aneurysm associated with celiac axis stenosis, management of stenosis should be considered in addition to local treatment of the aneurysm. In this context, division of median arcuate ligament and celiac plexus or aorto-celiac bypass may normalize the flows in the pancreaticoduodenal arcade and could be effective in preventing aneurysm reformation. (Received May 12, 1997; accepted Sept. 26, 1997)     

Corneoplastique?: Art of vision surgery

Corneoplastique incorporates the entire spectrum of Vision corrective surgery including Lasik, premium cataract surgery, corneal surgery, ocular surface surgery and the full range of anterior segment surgery itself in manipulating the optics of every eye towards unaided emmetropia to define each and every eye surgeon as a “Vision Corrective Surgeon”. This concept of approaching each case individually and designing vision therewith enables surgeons to correct not only virgin eyes but also approach complex cases and complications with the goal of 20/20 vision. Armed with this holistic approach, eye surgeons can use minimally invasive, aesthetically pleasing and visually focused surgery in single or staged process aiming for each patient''s Best Vision Potential (BVP) raising eye surgery itself then to an Art!     

放射状角膜切开术矫正准分子激光角膜切削术后残余近视

目的 评价放射状角膜切开术（ＲＫ）矫正准分子激光角膜切削术（ＰＲＫ）后残余近视的安全性、有效性及有关并发症。方法 分析１０例病人１４只眼用ＲＫ手术矫正ＰＲＫ后残余近视的屈光及视力变化。ＲＫ后最短观察时间６个月。结果 ３只眼（２１％）接受１次ＰＲＫ治疗,７只眼（５０％）接受２次ＰＲＫ治疗,４只眼（２９％）接受３次ＰＲＫ治疗。１１只眼（７９％）接受４刀Ｒ人眼（２１％）接受８刀ＲＫ术。所有病人ＲＫ术后裸     

Light and electron microscopic immunocytochemistry of β-endorphin/β-LPH-like immunoreactive neurons in the arcuate nucleus and surrounding areas of the rat hypothalamus

β-Endorphin/β-LPH-like immunoreactive neurons in the hypothalamic arcuate nucleus and its surrounding areas were visualized by light and electron microscopic immunocytochemistry. Immunoreactive processes were found in the vicinity of the pia mater, in the lateral part of the external layer of the median eminence and near the lateral wall of the third ventricle. Neuronal perikarya contained immunoreactive dense granules as well as developed cell organellae. They received neuronal inputs from other neurons through axoplasmic and axodendritic synapses. Immunoreactive neuronal processes containing dense granules and mitochondria were found as preterminal elements on non-immunoreactive neuronal soma and dendrites. Immunoreactive processes also make intimate contact with capillaries in the arcuate nucleus near the median eminence.     

Light and electron microscopic immunocytochemistry of GRF-like immunoreactive neurons and terminals in the rat hypothalamic arcuate nuclues and median eminence

Growth hormone-releasing factor (GRF) synthesizing neuronal perikarya and terminals were investigated by light and electron microscopic immunocytochemistry using rat hypothalamus. Immunoreactive neuronal perikarya were located mainly in the ventrolateral part of the arcuate nucleus. They contained well developed cell organella such as mitochondria and rough surfaced endoplasmic reticulum with some expansion. They also contained immunoreactive dense granules (80-120 nm in diameter). On the surface of the immunoreactive neuronal perikarya were frequently found non-immunoreactive axo-somatic synapses. Therefore, the GRF-like immunoreactive neurons were assumed to receive neuronal inputs from other neurons on their neuronal soma. In the external layer of the median eminence large numbers of immunoreactive terminals were distributed particularly around the capillaries of the portal vessel. Electron microscopic immunocytochemistry revealed large numbers of immunoreactive terminals containing immunoreactive dense granules, synaptic vesicles and mitochondria in the vicinity of the basement membrane of the pericapillary space of the portal vessel. Therefore, we concluded that GRF-like immunoreactive substances are released into the portal capillaries from the nerve terminals, which originate from the neuronal perikarya in the ventrolateral part of the arcuate nucleus, and act on growth hormone release in the anterior pituitary. We also suggest that GRF-like immunoreactive neurons have abundant terminal arborization in the external layer of the median eminence.     

大鼠弓状核损毁后睾丸超微结构的变化

已知初生期大鼠注射谷氨酸一钠(MSG)可引起下丘脑弓状核严重损毁。本研究证实,雄性大鼠生后2及4天经腹腔注射MSG(4mg/g体重),成年后睾丸电镜观察,曲细精管内各级生精细胞发生明显改变,胞质出现空泡,线粒体变性,嵴断裂;核膜缺损,核质疏松,染色体遭到严重破坏。提示:睾丸超微结构变化,可能来自于神经内分泌系统功能变化,与下丘脑弓状核损毁密切相关。     

角膜放射状切开术相关因素及预测性

对连续性１０５例（２０８眼）角膜放射状切开术患者进行了术后半年至一年的前瞻性研究。应用多元回归法分析手术相关因素，发现手术效果与切口深度，条数，原近视度数及术后加压等因素相关，其中前二项为主要因素。以二种方法计算了手术预测性；９０％可信限表示为３．１０ＤＳ；预期值与实际值之差在１．０，１．５，２．０以及３．０ＤＳ以内者分别为６２％，７６％，８４％和１００％。设计了自己的手术公式并制成计算机软件。