Endovascular Treatment of a Carotid Artery Pseudoaneurysm in a Contaminated Wound: Report of a Case

We herein report a case of carotid artery pseudoaneurysm following intensive treatment for hypopharyngeal carcinoma. An81-year-old male had undergone surgery and concurrent chemoradiotherapy to treat hypopharyngeal carcinoma (T4aN1M0).This treatment led to a complete response, but pseudoaneurysms were formed at the external carotid artery in a contaminatedwound. One of the pseudoaneurysms was located close to the bifurcation and thus caused intractable hemorrhaging. We performedendovascular treatment to achieve hemostasis. One year after the embolization, surgical removal of the endovasculardevices from the infected area was performed. Three years have passed since the removal, and the patient is still alive withoutany complications. Primary endovascular treatment of an infected pseudoaneurysm could be an effective option for the treatmentof acute lethal hemorrhaging

Activation of the pentose phosphate pathway in macrophages is crucial for granuloma formation in sarcoidosis

肉芽腫形成に特異的な代謝経路の発見 --ペントースリン酸回路の制御による新規治療--. 京都大学プレスリリース. 2023-12-01.More than skin-deep: Kyoto researchers discover metabolic pathway specific to granuloma formation in patients. 京都大学プレスリリース. 2023-12-07.Sarcoidosis is a disease of unknown etiology in which granulomas form throughout the body and is typically treated with glucocorticoids, but there are no approved steroid-sparing alternatives. Here, we investigated the mechanism of granuloma formation using single-cell RNA-Seq in sarcoidosis patients. We observed that the percentages of triggering receptor expressed on myeloid cells 2–positive (TREM2-positive) macrophages expressing angiotensin-converting enzyme (ACE) and lysozyme, diagnostic makers of sarcoidosis, were increased in cutaneous sarcoidosis granulomas. Macrophages in the sarcoidosis lesion were hypermetabolic, especially in the pentose phosphate pathway (PPP). Expression of the PPP enzymes, such as fructose-1, 6-bisphosphatase 1 (FBP1), was elevated in both systemic granuloma lesions and serum of sarcoidosis patients. Granuloma formation was attenuated by the PPP inhibitors in in vitro giant cell and in vivo murine granuloma models. These results suggest that the PPP may be a promising target for developing therapeutics for sarcoidosis

西部ケニアにおける小児の風土病型リンパ節型カポシ肉腫

風土病型カポシ肉腫(KS)は赤道アフリカに多く見られ，比較的小児にも好発し，また，リンパ節に発生するものも多く認められてきた。今までの我々の調査でも，小児に発生するKSは，主にリンパ節に初発していた。しかし，これらのKSに関する組織学的検討は，ほとんどなされていない。今回我々は，小児KSのうちリンパ節に初発した症例22例を用いて，地理病理学的，組織学的，免疫組織学的な検索を行い，その民族，地理的分布，組織学的形態像，細胞の由来，発生機序に関して検討した。その結果1)風土病型KSの好発年齢には，小児期と中高年齢期の二峰性が見られ，初発部位は小児では主にリンパ節で，多発する傾向が見られ，中高年齢期では四肢の皮膚に多く見られた。2)小児リンパ節型KSは，成人皮膚型KSと同様にLuo族に多く見られ，高温で多湿なピクトリア湖周辺に多く，乾燥した地域にはまれであった。3)KSはリンパ節のpara-cortical areaより発生し，reticulin networkに沿って増生していた。4)KSの病変部はspindle-shaped cell，macrophage-like cell，immature endothelial cell-like cell，mature blood vessel，lymphatic vessel，postcapillary venuleなどの細胞からなっていた。5)悪性を示唆する細胞異型，異型核分裂像，腫療による増殖性懐死，リンパ節被膜外への浸潤像などは認められなかった。6)免疫染色およびレクチン染色では，内皮細胞のマーカーであるFactor-VIIIRa，UEA-1はmature blood vesselなどのendothelial cellに陽性で，spindle-shaped cell，macrophage-like cell，immature endothelial cell-like cellは陰性であった。間葉系細胞のマーカーであるVimentinは，spindle-shaped cell，immature endothelial cell-like cell，mature blood vesselなどのendothelial cellに陽性であった。macrophage-like cellはFactor-XIIIRaのみ陽性で，KSの病変部に多く見られたが，KSの構成成分の一種であるか，反応性の増生であるかは不明であった。これらの結果より，KSの発生には自然環境，生活様式などの因子とともに遺伝因子など，いくつかの因子が強い影響を与えていると考えられた。また，KSはparacortical areaのreticulin network近傍の多潜能なmesenchymal cellより発生し，悪性腫療というよりは良性腫虜，あるいは反応性疾患と考えられた。We conducted an epidemiological and histological analysis of the endemic lymph node-type Kaposi\u27s sarcoma (KS) in African children (under 16 years old) in Western Kenya in order to determine the ethno-geographical distribution of the disease and to clarify its histological features and histogenesis during the 12-year period between 1979 to 1990. The age distribution of all endemic type KS in Western Kenya showed two age peaks; one in early childhood and the other in middle to advanced age. Most endemic KS in children initially occurred in the lymph nodes, while that of people of middle to advanced age showed a primary lesion in the skin. The male to female ratio of the endemic KS was 3.1 to 1 (in all pediatric types), 3.4 to 1 (in the pediatric lymph node-type) and 10.8 to 1 (in all adult types). A high incidence of the lymph node-type KS in children was observed in the Luo group ethnically and in Nyanza Province around Lake Victoria geographically. The lymph node-type KS originated at the paracortical areas and gradually grew along the reticulin network originating from the trabeculae. The lesion of KS histologically consisted of several types of cells, especially spindle-shaped cells, macrophage-like cells and immature endothelial cell-like cells and was accompanied by almost normal small blood vessels, lymphatic vessels and postcapillary venules. No abnormal mitoses were observed in any of the cells. There were no primary necroses due to tumor proliferation and also no extracapsular invasions. Immunohistochemically, spindle-shaped cells, immature endothelial cell-like cells and mature endothelial cells were positive for Vimentin, but only mature endothelial cells were positive for Factor-XIIIRa and UEA-1. Macrophage-like cells were positive for Factor-XIIIRa. These findings suggested that: 1) there are certain differences in the etiological co-factors of KS between the endemic lymph node-type KS in children and the endemic cutaneous type KS in adults, 2) KS cells originate from pluripotent mesenchymal cells and 3) KS might not be a malignant tumor, but rather a benign neoplasm, tumor-like lesion or reactive hyperplasia

Glaciological and meteorological observations at the SIGMA-D site, northwestern Greenland Ice Sheet

During spring 2014, we drilled an ice core on the northwestern Greenland Ice Sheet, recovering a core of total length 225m.　We also conducted stratigraphic observations, measurements of the density of the ice core, near-infrared photography of the ice core, preparation of liquid samples for chemical analysis, and measurements of borehole temperature.　The pore close-off depth was 60m, and the temperature in the borehole was −25.6°C at a depth of 10m.　In addition, we conducted snow-pit observations, ice-velocity and surface-elevation measurements using the global positioning system (GPS), meteorological observations, and installation of an automated weather station (AWS)

A Comparative Light Microscopic Study and Clinical Evaluation on Acute Viral Hepatitis Type A, B, and Non-A, Non-B

We studied a total of 55 patients with acute hepatitis type A (7 patients), B (20 patients) and non-A, non-B (28 patients) on light microscopic differences of their liver biopsies and their clinical evaluations. We found that the frequency and degree of some histological features seem to be characteristic to each type of hepatitis. In the liver parenchyma, the degree of necrosis was observed to be more severe in type A and B, extending necrosis was observed in type B and non-A, non-B, and reticuloendothelial reaction was more prominent in type B and non-A, non-B. In the portal area, bile duct lesions were frequently seen in type B and non-A, non-B. Although some predominant findings in each type hepatitis were observed, we could not find any specific differences which separate the three types of hepatitis histologically. Clinically and biochemically acute hepatitis type A showed the high degree of liver dysfunction and more rapid resolution than other types of B and non-A, non-B. On the other hand, acute hepatitis type non-A, non-B showed relatively mild liver dysfunction than other types of A and B but slowly resolved during the convalescent stage and some of them showed progression to chronicity