Successful stenting of the ductus venosus in 2 neonates with asplenia syndrome complicated by infracardiac type total anomalous pulmonary venous connection

SummaryIn the neonatal period, the surgical mortality of palliation is extremely high for asplenia syndrome complicated by single ventricle combined with total anomalous pulmonary venous connection (TAPVC). Recently, stent implantation for the pulmonary venous drainage route soon after birth has been used instead of surgery to prevent pulmonary venous occlusion and to maintain stable hemodynamics in the neonatal period or in early infancy. Here, we successfully implanted stents in the ductus venosus (DV) in 2 neonates with asplenia syndrome complicated by infracardiac type TAPVC. The first patient was a 3-day-old male neonate with severe cyanosis. Immediately after TAPVC was diagnosed, we implanted a stent in the DV. The second patient was a 0-day-old female neonate. She was diagnosed as TAPVC by fetal echocardiogram. After the scheduled delivery, a stent was successfully implanted. We believe that stent implantation in the DV in the neonatal period is effective and less invasive than surgery in patients with infracardiac type TAPVC

Brain Abscess Associated with Polymicrobial Infection after Intraoral Laceration: A Pediatric Case Report

Brain abscesses, infections within the brain parenchyma, can arise as complications of various conditions including infections, trauma, and surgery. However, brain abscesses due to polymicrobial organisms have rarely been reported in children. We herein report a case of a 9-year-old girl with unresolved congenital cyanotic heart disease (CCHD) presenting with right hemiplegia who was diagnosed with brain abscess caused by Streptococcus intermedius, Parvimonas micra, and Fusobacterium nucleatum after oropharyngeal injury. She was treated with intravenous antimicrobial therapy, drainage under craniotomy, and antiedema therapy with glycerol and goreisan, which led to the improvement of right hemiplegia to baseline; she was discharged following eight weeks of intravenous antimicrobial therapy. The clinical diagnosis of the brain abscess was difficult due to the nonspecific presentation, highlighting the importance of cranial imaging without haste in patients at increased risk for brain abscesses such as those with CCHD, presenting with fever in the absence of localizing symptoms or fever, accompanied with abnormal neurological findings

Drinking Citrus Fruit Juice Inhibits Vascular Remodeling in Cuff-Induced Vascular Injury Mouse Model

<div><p>Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% <i>Citrus unshiu</i> (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% <i>Citrus iyo</i> (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI.</p></div

Effect of drinking citrus fruit juice on superoxide anion production induced in injured artery.

<p>Tissue samples were prepared from cuffed arteries 7 days after operation. Representative photos of injured femoral artery in cross-sections after dihydroethidium staining (A) and fluorescence intensity in intima and media (B). CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice. **p<0.01 vs. Cuff (+) Control. Values are mean ± SEM (n = 7 to 8 for each group).</p

Comparison of contents and ingredients between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.

<p>Comparison of contents and ingredients between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.</p

Effect of drinking citrus fruit juice on immune cell infiltration.

<p>Comparison of filtration of macrophage and neutrophils in injured femoral artery 7 days after cuff placement. Representative photos of injured femoral artery in cross-sections after immunofluorescent staining using antibodies against a macrophage marker, F4/80 and a neutrophil marker, LY-6G/-6C. CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice.</p

Effect of drinking citrus fruit juice on inflammatory cytokines.

<p>Expression of TNF-α, MCP-1, IL-6, and IL-1β determined by real-time quantitative RT-PCR in femoral artery 7 days after cuff placement. Tissue samples were prepared from cuffed arteries 7 days after operation. CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice. Values are mean ± SEM (n = 4 for each group).</p

Effect of drinking citrus fruit juice on neointima formation.

<p>Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% <i>Citrus unshiu</i> (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% <i>Citrus iyo</i> (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Samples were prepared from cuffed-femoral arteries of C57BL/6J mice as described in Methods. A, Representative photos of neointimal area in cross-sections of femoral artery with elastic van Gieson staining 14 days after cuff placement at 100x magnification. B, Higher magnified photos at 400x magnification described as squares in Figure A. Scale bars show 50 μm in each photo. C, Quantitative analysis of neointimal area in injured femoral artery. Values are mean ± SEM (n = 6 for Cuff (-), n = 8 for other groups). *p<0.05, **p<0.01 vs. Cuff (+) Control, †p<0.05 vs. administration of juice of different citrus fruit at same %.</p