Anesthesia in a severe anorexic with cirrhosis

Recent advancements in intensive care have increased the number of severe anorexia nervosa patients presenting for surgery. We provided anesthesia to a patient who had a 22-year history of anorexia with life-threatening cirrhosis. Although surgery should be avoided in patients with end-stage cirrhosis, she was in the best preoperative optimized condition compared to her condition over the past few years. Potential complications are heart failure easily caused by deterioration of cirrhosis, lethal arrhythmias related to electrolyte disturbances and increased myocardial sensitivity to drugs, and refeeding syndrome in the postoperative period. The several rare events that we experienced are worth reporting

Up-To-Date Magnetic Resonance Imaging Findings for the Diagnosis of Hypothalamic and Pituitary Tumors

Magnetic resonance imaging (MRI) is the preferred imaging technique for the sellar and parasellar regions. In this review article, we report our clinical experience with MRI for hypothalamic and pituitary lesions, such as pituitary adenomas, craniopharyngiomas, Rathke cleft cysts, germinoma, and hypophysitis with reference to the histopathological findings through a review of the literature. Our previous study indicated that three dimensional-spoiled gradient echo sequence is a more suitable sequence for evaluating sellar lesions on postcontrast T1 weighted image (WI). This image demonstrates the defined relationship between the tumor and its surroundings, such as the normal pituitary gland, cavernous sinus, and optic pathway. We demonstrated the characteristic MRI findings of functioning pituitary adenoma. In growth hormone-producing adenoma, signal intensity on T2WI is important to differentiate densely from sparsely granulated somatotroph adenomas. In prolactin-producing pituitary adenomas, distinct hypointense areas in early phase on T2WI, possibly owning to diffuse hemorrhage, indicate pronounced regressions of invasive macroprolactinomas during cabergoline therapy. The two histopathological subtypes, adamantinomatous and squamous papillary craniopharyngioma, differ in genesis. Calcified tumors are mostly adamantinomatous type. On MRI, these lesions have a heterogenous appearance with a solid portion and cystic components. The solid portions and cyst wall enhance heterogeneously. Although cyst fluid of Rathke cleft cysts show variable intensities on MRI, intracystic waxy nodule can be hypointense on T2WI. The enhancing cyst wall may contain the squamous metaplasia. Cystic lesions of the sellar and parasellar areas may be difficult to differentiate on a clinical, imaging, or even histopathological basis

Human papillomavirus DNA in cell lines derived from malignancies.

The presence of high-risk types of human papillomavirus (HPV) 16, 18 and 33 in cell lines established from several malignancies including 5 of cervical cancer and 6 of head and neck cancer was studied. HPV DNA, either type 16 or 18, was detected by polymerase chain reaction, and by Southern blot hybridization in all of the cell lines derived from cervical cancers. The hybridization patterns of HPV DNA after endonuclease digestion differed among cell lines, suggesting that all of these cell lines were independent isolates. Accordingly, high-risk types of HPV DNA seem to be ubiquitous in cervical cancer. HPV DNA was not detected in the cell lines derived from head and neck cancers or from any other malignancies besides cervical cancer in this study.</p

Genotoxicity of styrene oligomers extracted from polystyrene intended for use in contact with food

AbstractHere, we conducted in vitro genotoxicity tests to evaluate the genotoxicity of styrene oligomers extracted from polystyrene intended for use in contact with food. Styrene oligomers were extracted with acetone and the extract was subjected to the Ames test (OECD test guideline No. 471) and the in vitro chromosomal aberration test (OECD test guideline No. 473) under good laboratory practice conditions. The concentrations of styrene dimers and trimers in the concentrated extract were 540 and 13,431 ppm, respectively. Extraction with acetone provided markedly higher concentrations of styrene oligomers compared with extraction with 50% ethanol aqueous solution, which is the food simulant currently recommended for use in safety assessments of polystyrene by both the United States Food and Drug Administration and the European Food Safety Authority. And these high concentrations of styrene dimers and trimers were utilized for the evaluation of genotoxicity in vitro. Ames tests using five bacterial tester strains were negative both in the presence or absence of metabolic activation. The in vitro chromosomal aberration test using Chinese hamster lung cells (CHL/IU) was also negative. Together, these results suggest that the risk of the genotoxicity of styrene oligomers that migrate from polystyrene food packaging into food is very low

Structural variations in parotid glands induced by radiation therapy in patients with oral carcinoma observed on contrast-enhanced computed tomography

Background: Xerostomia is one of the commonest radiation-induced complications in patients with head and neck carcinoma. The aim of this study was to assess structural variations in parotid glands induced by radiation therapy in patients with oral carcinoma with contras-enhanced computed tomography (CECT). Material/Methods: A retrospective study was performed in 41 patients with oral carcinoma who underwent CECT for head and neck malignancies before and after radiotherapy. We analyzed the relationship between parotid density variations, parotid volume change, as seen on CECT, and the mean radiation dose applied to the parotid glands in patients with oral carcinoma immediately after radiotherapy, and 2 and 3 years later. Results: Immediately after radiotherapy, high-density changes on contrast-enhanced CT were observed in 70.5% of the irradiated parotids. Low-density changes due to fat degeneration were seen in 46.2% and 72.2% of the irradiated parotids 2 and 3 years after radiotherapy, respectively. The mean dose applied to the parotids with the low-density changes and without such changes 3 years after radiotherapy was 46.0 Gy and 27.7 Gy, respectively (p=0.049). Furthermore, parotid shrinkage was observed in 63.6% of the irradiated parotids. Conclusions: This study suggests that the structural variations in parotid glands induced by radiotherapy included high-density changes that were observed immediately after radiotherapy and low-density changes that were seen at late follow-up. This study should be useful for clinicians in the assessment of radiation-induced injuries in the parotids with respect to early prediction of xerostomia

1250nm帯モード同期クロム・フォルステライトレーザーを光源とした第2高調波発生光顕微鏡によるヒト顔皮膚の老化性真皮コラーゲン構造変化のその場観察

In vivo visualization of human skin aging is demonstrated using a Cr:Forsterite (Cr:F) laser-based, collagen-sensitive second harmonic generation (SHG) microscope. The deep penetration into human skin, as well as the specific sensitivity to collagen molecules, achieved by this microscope enables us to clearly visualize age-related structural changes of collagen fiber in the reticular dermis. Here we investigated intrinsic aging and/or photoaging in the male facial skin. Young subjects show dense distributions of thin collagen fibers, whereas elderly subjects show coarse distributions of thick collagen fibers. Furthermore, a comparison of SHG images between young and elderly subjects with and without a recent life history of excessive sun exposure show that a combination of photoaging with intrinsic aging significantly accelerates skin aging. We also perform image analysis based on two-dimensional Fourier transformation of the SHG images and extracted an aging parameter for human skin. The in vivo collagen-sensitive SHG microscope will be a powerful tool in fields such as cosmeceutical sciences and anti-aging dermatology.博士（医学）・乙第1311号・平成25年5月29