ALTA コウカ リョウホウゴ ニ ダイ4 ノ ジ ドウミャク カラ シュッケツ サイハツ オ クリカエシタ 1 レイ

A６９-year-old man was referred to our hospital for aluminum potassium sulfate and tannic acid （ALTA）sclerosing therapy for bleeding internal hemorrhoids. After two months from the first ALTA sclerosing therapy, he had recurrence with bleeding on defecation. The ALTA injection on the left anterior hemorrhoidal artery（one o’clock position）stopped bleeding. One o’clock position hemorrhoidal artery existed in ５８．６％ and called fourth hemorrhoidal artery. We first recognized pulsation of hemorrhoidal artery by the Doppler ultrasound probe and then we performed ALTA sclerosing therapy

カントン ジカク ノ ホゾンテキ チリョウゴ ニ コンジ シュジュツ トシテ ＡＬＴＡ オ シコウ シタ 1 レイ

Aluminum potassium sulfate and tannic acid（ALTA）are able to induce noninvasive sclerosis and involution of hemorrhoids through initiation of inflammatory reaction. A７７-year-old man was admitted to our hospital for an incarcerated hemorrhoid. We first performed the conservative treatment. After three weeks, we performed ALTA sclerosing therapy. Although he had necrosis at the injection site and an anoderm ulcer on the１st post-operative day, he had few of pain and fever. He was cured on the３２nd post-operative day. Although he had recurrence on the３０６th post-operative day, we performed re-ALTA sclerosing therapy. After that, he had no relapse and had good quality of life. For incarcerated hemorrhoids, the ALTA sclerosing therapy might be performed after some period of the conservative treatment

ステロイド チョウキ トウヨ カンジャ ニオケル シュウジュツキ ステロイド カバー

In patients receiving chronic corticosteroid therapy, the adrenocortical function has decreased because of suppression of the hypothalamic-pituitary-adrenal axis. Under such a condition, it is easy to fall into a serious acute adrenocortical insufficiency during surgical stress. Corticosteroid supplementation is done as prevention of adrenocortical insufficiency. It is changing from corticosteroid supplementation of high dose into that of low dose that based on extrapolation from what constitutes a normal cortisol response to stress in recent years. On the other hand, some authors reported that patients receiving therapeutic doses of corticosteroids who undergo a surgical procedure do not routinely require corticosteroid supplementation so long as they continue to receive their usual daily dose of corticosteroid. Therefore, furthermore investigation should be necessary

ムジュウリョク ニヨル キンイシュク ト ソノ ショクジ ニヨル ヨボウ

The elucidate the mechanisms of microgravity-induced muscle atrophy, we focused on fast-type myosin heavy chain (MHC) degradation and expression of proteases in atrophied gastrocnemius muscles of neonatal rats exposed to 16-d spaceflight (STS-90). The spaceflight stimulated ubiquitination of proteins, including a MHC molecule, and accumulation of MHC degradation fragments in the muscles. Semi-quantitative RT-PCR revealed that the spaceflight significantly increased mRNA levels of cathepsin L, proteasome components, polyubiquitin, and ubiquitin-conjugating enzyme in the muscles, compared with those of ground control rats. The levels of μ-calpain, m-calpain, cathepsin B, and cathepsin H mRNAs were not changed by the spaceflight. We also found that tail-suspension of rats for 10 d or longer caused the ubiquitination and degradation of MHC in gastrocnemius muscle, as was observed in the spaceflight rats. In the muscle of suspended rats, these changes were closely associated with activation of proteasome and up-regulation of expression of mRNA for the proteasome components and polyubiquitin. Administration of a cysteine protease inhibitor, E-64, to the suspended rats did not prevent the MHC degradation. Our results suggest that spaceflight induces the degradation of muscle contractile proteins, including MHC, possibly through a ubiquitin-dependent proteolytic pathway. To elucidate whether the ubiquitination was accompanied with oxidative stress, we measured markers for oxidative stress, such as thiobarbituric acid-reactive substance (TBARS) and glutathione disulfide (GSSG), in gastrocnemius muscle of tail-suspended rats. Glutathione (GSH) concentration in the muscle significantly decreased from Day 5 and reached a minimum value on Day 10. Tail-suspension reciprocally increased concentrations of TBARS and GSSG in parallel with enhancement of protein ubiquitination, suggesting that oxidative stress may play an important role in protein ubiquitination caused by tail-suspension. To prevent ubiquitination associated with oxidative stress, we also administered an antioxidative nutrient, cysteine, to tail-suspended rats. Intragastric supplementation of 140 mg/rat of cysteine for 2 wks or longer normalized the ratio of GSH to GSSG in the muscle and suppressed protein ubiquitination and MHC fragmentation, compared with supplementation of the equimolar amount of alanine. The cysteine supplementation significantly suppressed the loss of hindlimb muscle weight. Our results also suggest that supplementation of antioxidative nutrients, such as cysteine, may be beneficial to prevent ubiquitination of muscle protein caused by unweighting

フクブ ショクドウ チョウフクショウ ニ タイシ フククウキョウカ テキシュツジュツ オ シコウ シタ １レイ

A 9-year-old boy was admitted to the hospital for close exploration of cystic tumor of the esophagus ventral detected in the abdominal contrast CT scan during the investigation of hematuria. Upper gastrointestinal fluoroscopic and endoscopic examination with ultrasonography showed a cystic tumor with the diameter of 2cm and smooth surface in the abdominal esophagus. Laparoscopic surgery was performed under the diagnosis of abdominal esophageal duplication cyst. At surgery, the soft and well-defined mass was present in the abdominal esophagus ventral and continuous with the esophagus wall. Histopathological study showed the cystic wall was lined with the pseudostratified ciliated epithelium and subepithelial muscle layer. These findings indicated abdominal esophageal duplication cyst. He was discharged on postoperative day 8 with good postoperative course. Abdominal esophageal duplication cyst is a rare disease. Laparoscopic surgery, which has not seen attempted before this case, seems to be a useful treatment of abdominal esophageal duplication cyst

Abrogation of Rbpj attenuates uveoretinitis

Experimental autoimmune uveoretinitis (EAU) is an organ-specific T cell-mediated disease induced by immunizing mice with interphotoreceptor retinoid binding protein (IRBP). Autoaggressive CD4+ T cells are the major pathogenic population for EAU. We investigated the contribution of Notch signaling in T cells to EAU pathogenesis because Notch signaling regulates various aspects of CD4+ T cell functions. Rbpj is required for Notch signaling, and Rbpj deficiency in T cells inhibited EAU disease severity. The amelioration of EAU in T cell-specific Rbpj-deficient mice correlated with low levels of IL-22 production from CD4+ T cells, although IRBP-specific CD4+ T cell proliferation and Th17 differentiation were unaffected. Administration of recombinant IL-22 during the late phase, but not the early phase, of EAU increased EAU clinical scores in T cell-specific Rbpj-deficient mice. Notch inhibition in mice immunized with IRBP with a γ-secretase inhibitor (GSI) suppressed EAU progression, even when GSI was administered as late as 13 days after IRBP immunization. Our data demonstrate that Rbpj/Notch-mediated IL-22 production in T cells has a key pathological role in the late phase of EAU, and suggest that Notch blockade might be a useful therapeutic approach for treating EAU

Clinical role of Foxp3+regulatory T cell in Living donor related liver transplantation for prediction of life-threatening complications

Purposes : It is no doubt that regulatory T cells (Foxp3+CD4+CD25+T cells : Treg) play important roles in transplant immunity.We investigated the significance of Treg expression in acute stage of living donorrelated liver transplantation (LDLT) for the possibility of the sensitive marker for immunological state and homeostatic stress after liver transplantation. Methods : Peripheral blood was drawn from 5 recipients of LDLT preoperatively and on post operative 1, 4, 7, and 14 days. The peripheral blood mononuclear cells (PBMCs) were stained with CD4, CD25, Foxp3, and were analyzed with FACScan. This data was compared with clinical output of LDLT. Result : The populations of Treg were significantly decreased in all patients on day 1 after LDLT and significantly increased in patients who had early postoperative complications compared with patients who had no complications. Conclusions : The population of Treg in peripheral blood may reflect the surgical stress such as life-threatening complications after LDLT