Comparing the cochlear spiral modiolar artery in type-1 and type-2 diabetes mellitus:a human temporal bone study

This study examined whether pathological findings were present in cochlear vessels for patients with diabetes mellitus. Twenty-six temporal bones from 13 patients with type 1 diabetes mellitus and 40 temporal bones from 20 patients with type 2 diabetes mellitus were examined. Type 2 diabetic temporal bones were divided into 2 groups according to diabetic management (22 temporal bones with insulin therapy, and 18 with oral hypoglycemic drugs). Age-matched normal control temporal bones were also selected. The vessel wall thickness in the cochlear spiral modiolar artery was measured under a light microscope, and the vessel wall ratio (vessel wall thickness/outer diameter of the vessel×100) was calculated. The vessel wall thickness and vessel wall ratio in type 1 diabetes mellitus were significantly greater than in normal controls. Type 2 diabetic patients with insulin therapy showed significantly greater vessel wall thickness and vessel wall ratios than controls. In type 2 diabetes mellitus, the vessel wall thickness and vessel wall ratio were greater in patients treated with insulin therapy than in those treated with oral hypoglycemic agents. Type 2 diabetic patients with insulin therapy showed an increased vessel wall thickness and vessel wall ratio compared to patients with type 1 diabetes mellitus. In conclusion, the cochlea in patients with diabetes mellitus shows circulatory disturbance compared to age-matched normal controls

Synchronous Double Malignant Tumors Consisting of Stomach and Hodgkin’s Lymphoma with Collision between Gastric Adenocarcinoma and Hodgkin’s Lymphoma in the Stomach

We report the rare case of a 72-year-old man with double cancers (gastric adenocarcinoma and Hodgkin’s lymphoma) with collision between gastric adenocarcinoma and Hodgkin’s lymphoma. Abdominal computed tomography showed increased wall thickness in the fundus region of the stomach and multiple lymph node swellings in the lesser curvature, periceliac and left cardial regions. Upper gastrointestinal endoscopy showed an ulcer approximately 5 cm in diameter with a malignant appearance in the fundus region of the stomach. On histopathologic examination, two completely different tumors were recognized in the stomach. One tumor was a poorly differentiated adenocarcinoma characterized by poorly developed tubular structures associated with prominent lymphoid infiltration of the stroma. The other tumor was found to have proliferated in the wall of the stomach, with diffuse granulomatous lesions and bordering the adenocarcinoma. Large atypical lymphoid cells with prominent nucleoli and enlarged mononuclei or multinuclei were seen in the latter tumor. Hodgkin’s lymphoma was also found in the swollen lesser curvature lymph nodes. As a result, gastric adenocarcinoma and metastasis of Hodgkin’s lymphoma were collided in the stomach. In conclusion, this case might be helpful in exploring the occurrence mechanism of tumor collision between lymphoma and carcinoma

Three-stage total knee arthroplasty combined with deformity correction and leg lengthening using Taylor spatial frames and conversion to internal fixation for severe intra- and extra-articular deformities and hypoplasia in a patient with hemophilic knee arthropathy : A case report

Background: Hemophilic arthropathy is a cause of severe knee deformity, because chronic synovitis due to repeated hemarthrosis affects the area of the epiphyseal plates in juvenile cases. Total knee arthroplasty (TKA) is the standard treatment for end-stage knee arthropathy. However, it is difficult to perform one-stage TKA in patients with severe intra- and extra-articular deformities. Case presentation: We reported a case of hemophilic arthropathy in a 55-year-old male with leg length discrepancy of 4 cm, limited range of knee motion (40 degrees extension and 85 degrees flexion), intra-articular deformity (medial proximal tibial angle: 69 degrees; mechanical lateral distal femoral angle: 79 degrees), extra-articular deformity at the distal femoral metaphyseal (30 degrees valgus and 45 degrees flexion deformity), and varus malalignment (% mechanical axis: 33%). We planned a three-stage TKA. Firstly, we performed gradual correction and lengthening of the distal femur using Taylor spatial flame. Six months after surgery, we performed conversion surgery from external fixation to internal fixation. Finally, we performed TKA with rotating hinged type implant. Two years after surgery, physical examination showed a normal gait, leg length discrepancy of 2 cm (the right leg was shorter), improvement in the range of knee motion (0 degrees extension and 100 degrees flexion). Conclusion: To the best of our knowledge, this presents the first combination of three-stage TKA with correction of femoral deformity and leg lengthening using a Taylor spatial frame and conversion to internal fixation in a patient with hemophilic knee arthropathy and severe intra- and extra-articular deformities