Ultraflex expandable stents for the management of air leaks.

Postoperative empyema and aspergillosis were diagnosed in a 66-year-old man. Since non-operative therapy was not effective, we performed surgery. On the 8th postoperative day, a covered Ultraflex expandable stent (Boston Scientific, Galway, Ireland) was implanted to make a one-way airway for blocking a major air leak from a bronchopleural fistula causing respiratory distress. His general condition improved gradually, and he was discharged 30 days after stenting. In conclusion, we used a covered Ultraflex expandable stent to make an airway to block an air leak. This may be a new application for this stent.     

Lymphoepithelioma-like carcinoma of the trachea.

Lymphoepithelioma is a lymphocyte-rich, poorly differentiated and non-keratinizing squamous cell carcinoma of the nasopharynx. Tumors arising outside the nasopharynx are rare and are designated as lymphoepithelioma-like carcinomas (LELCs). This is the third reported case of LELC of the trachea. A 27-year-old woman was referred to our hospital on suspicion of bronchial asthma on August 2000. A polypoid tumor of the cervical trachea was recognized on neck X-ray, neck computed tomography (CT) scan, and fiberoptic bronchoscopy. The protruding tumor was resected endoscopically by an electrosurgical snare. Histological and immunohistochemical examinations demonstrated large irregular polygonal cells extending in an islet or trabecular pattern among lymphoid stroma. These polygonal cells showed non-keratinization, atypia and prominent nucleoli. In situ hybridization showed these cells were infected with the Epstein-Barr (EB) virus. The infiltrating lymphocytes consisted of both T-and B-lymphocytes with no atypia. Thus the tumor was diagnosed as LELC. Blood examination revealed a past EB viral infection. Sphenoid resection of the tracheal cartilaginous portion was performed for residual tumor. We gave 50 Gy postoperative radiation, and she has been disease free in the 6-year follow-up period.     

Choroidal dye filling velocity in patients with Vogt–Koyanagi–Harada disease

Purpose To evaluate quantitative choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease (VKH) before and after corticosteroid treatment using indocyanine green (ICG) angiography.Methods ICG angiography was performed in seven VKH patients before and after systemic corticosteroid treatment. Choroidal dye curves were obtained by image analysis software and analyzed using an exponential model. The model’s time constant (τ) was used to evaluate choroidal dye filling velocity.Results Compared with controls, acute phase choroidal τ values in VKH patients were significantly longer, suggesting choroidal circulation disturbance. During the recovery phase, choroidal τ values were significantly shortened, suggesting choroidal circulatory disturbance improvement.Conclusion Choroidal dye filling velocity may be useful for VKH diagnosis and verification of corticosteroid treatment effectiveness.     

Nuclear bridges in multinucleated giant cells associated with primary lymphoma of the brain in acquired immune deficiency syndrome (AIDS)

Summary In an autopsied case of a 37-year-old man with acquired immune deficiency syndrome (AIDS), multinucleated giant cell encephalopathy was noted in close proximity to multiple nodules of primary lymphoma of the brain. Some multinucleated giant cells and macrophages contained HTLV-III-like viral particles. Nuclear bridges, thin strands connecting individual nuclei with one another, were observed with both light and electron microscopes within some of the multinucleated giant cells. There were also thin tapering nuclear processes, which were probably part of nuclear bridges. The possibility that the nuclear bridges and processes represent amitotic nuclear division is discussed.     

An experimental study for analyzing nerve conduction velocity

Conduction velocities of so called A fibers in the bullfrog's sciatic-peroneal nerve were studied by means of a collision neurography in which a submaximal shock to the distal part of the nerve was used to block descending impulses from a supramaximal shock delivered to the proximal two parts of the same nerve respectively. The onset latency of the response to stimulation delivered to the proximal part was almost unchangeable within a certain range of the stimulus intensity of the distal part and fell into 3 classes, and then conduction velocities of so called A fibers were divided into 3 groups. These findings were in good agreement with those obtained by Erlanger and Gasser (1937) using monophasic recording. On the other hand, the distribution of the external diameter of myelinated nerve fibers examined was unimodal. It may depend on the change in threshold due to stimulation through fluid electrodes that the onset latency of the response of a nerve trunk was divided into 3 classes.     

Superoxide dismutases of muscle in mitochondrial encephalomyopathies

Lmmunohistochemical analyses were made of the superoxide dismutases (Mn-SOD and CuiZn-SOD) in biopsied muscles from 7 patients with mitochondrial encephalomyopathies that included mitochondrial encephalomyopathy, lactic acidosis and strokelike episodes (MELAS), and chronic progressive external ophthalmoplegia (CPEO). Mn-SOD mainly was present in the subsarcolemmal region, but it also was found in a coarsely granular, reticular, or diffuse pattern of staining within the muscle fibers. These Mn-SOD-positive fibers corresponded almost completely to the ragged-red fibers. The immunoreaction for CuiZn-SOD was weakly positive in some of the muscle fibers positive for Mn-SOD. In CPEO, Mn-SOD-positive fibers predominantly showed decreased cytochrome c oxidase (COX) activity. In MELAS, Mn-SOD-positive fibers tended to be stained deeply for COX although a few were COX-negative. These findings suggest that Mn-SOD-positive fibers can be used to make a differential diagnosis between CPEO and MELAS and that in mitochondrial encephalomyopathies Mn-SOD in the raggedred fibers may protect against oxidative stress. © John Wiley & Sons, Inc.     

Treatment strategies for hepatic metastasis from colorectal cancer

Hepatic micrometastases of the parenchyma adjacent to a macroscopic lesion were detected in 17 of 31 resected liver metastases. Fifty-nine micrometastatic lesions were detected in total; 26 lesions were situated in the portal vein (PV), 22 in the central vein (CV), 5 in the bile duct (BD), and 6 in the sinusoid (SS). A histological study confirmed the direct invasion of the macrometastatic cancer cells into the adjacent PV, CV, BD, and SS. According to the tumor doubling time, the mean diameter of the macrometastases in 19 remnant livers was calculated to have been 0.57±0.87 cm at the time of the primary resection. The calculated diameter of 3 of these 19 macrometastases was found to be less than 0.01 cm, the minimum implantable size, indicating that the cancer recurrence in these specimens may have developed from macroscopic metastatic lesions as a satellite, and not from the primary tumor. In 13 patients who received doses of 5250 mg or more of 5 fluorouracil (FU) via the hepatic artery, the cumulative disease-free rate 2 years postoperatively was 100%; this value was 47.6% in 11 patients who received less than 5250 mg of 5 FU via the hepatic artery, and 0% in 39 patients who received no chemotherapy (P<0.005). These results suggest that anatomical hepatic resection for satellite lesions, combined with prophylactic hepatic arterial chemotherapy for micrometastases, decreases the recurrence rate of hepatic metastases in the remnant liver.