Cholelithiasis with a cholecystoduodenal fistula complicated with paroxysmal nocturnal hemoglobinuria

　In cases of paroxysmal nocturnal hemoglobinuria (PNH), attention must be paid to potential complications such as thrombosis and hemolysis due to perioperative stress and infection from complement activation. Here we present the case of a 61-year-old Japanese woman with PNH. We made the diagnosis of PNH when she was 28 years old, and we administered repeated steroid medication and erythrocyte transfusion. The patient's cholecystocholedocholithiasis with a cholecystoduodenal fistula was diagnosed based on a survey of the right hypochondriac pain. We performed endoscopic nasobiliary drainage (ENBD) for the prophylaxis of perioperative infection, plus a cholecystectomy and fistulectomy. There were no complications, including hemolysis attack, infection, thrombosis with irrigation erythrocyte transfusion, steroid cover, or the need for heparin administration during the perioperative period. The reduction of the complement activation is necessary in the perioperative management of PNH patients. The prevention of the development of acidosis and hypoxemia, the selection of washed red blood cells, steroid use, appropriate infection measures and thrombosis prophylaxis are all important for the prevention of complications

Annexin V assay-proven anti-apoptotic effect of ascorbic acid 2-glucoside after cold ischemia/reperfusion injury in rat liver transplantation.

Controversy exists over whether the predominant cell death of hepatocytes is due to apoptosis or necrosis after ischemia/reperfusion injury. In this study we investigated the predominant cell death of hepatocytes after cold ischemia/reperfusion injury using the Annexin V-based assay, and evaluated the anti-apoptotic effect of ascorbic acid 2-glucoside (AA-2G) added to the University of Wisconsin solution (UW solution) in rat liver transplantation. The retrieved liver was preserved in 4 UW solution for 24 h, and then transplanted orthotopically to the syngeneic Wistar recipient. The animals were divided into 2 groups, a control group (n=10), in which liver grafts were preserved in UW solution (4), and an AA-2G group (n=10), in which liver grafts were preserved in UW solution (4) with AA-2G (100 ug/ml). The serum AST level 4 h after reperfusion in the control group was significantly suppressed in the AA-2G group, and the bile production of the liver graft in the AA-2G group was well recovered. The mean survival time in the AA-2G group was significantly improved compared with that in the control group. Annexin-V and Propidium iodide staining 4 h after reperfusion showed a significantly higher percentage of viable hepatocytes in the AA-2G group compared with the control group (93.4 +/- 2.0 vs. 80.3 +- 2.1%, P&#60;0.05). In the control group, the main cell death of hepatocytes was apoptosis (early apoptosis: 10.0 +- 4.7%, late apoptosis: 6.4 +/- 1.7%). The addition of AA-2G to the UW solution significantly inhibited both early and late apoptotic cell death 4 h after reperfusion (early apoptosis: 0.98 +/- 0.88%, late apoptosis: 2.2 +/- 1.1%). The expression of caspase 9 in the immunostaining of the liver graft was suppressed in the AA-2G group compared with in the control group. Our study using the Annexin V-based assay provided evidence that the predominant cell death of hepatocytes was apoptosis after 24 h cold ischemia/reperfusion injury in rat liver transplantation. The addition of AA-2G to the UW solution attenuated 24 h cold ischemia/reperfusion injury by inhibiting the apoptosis of hepatocytes.</p

Polysilsesquioxanes for Gate-Insulating Materials of Organic Thin-Film Transistors

Printable organic thin-film transistor (O-TFT) is one of the most recognized technical issues nowadays. Our recent progress on the formation of organic-inorganic hybrid thin films consists of polymethylsilsesquioxane (PMSQ), and its applications for the gate-insulating layer of O-TFTs are introduced in this paper. PMSQ synthesized in toluene solution with formic acid catalyst exhibited the electric resistivity of higher than 1014 Ω cm after thermal treatment at 150°C, and the very low concentration of residual silanol groups in PMSQ was confirmed. The PMSQ film contains no mobile ionic impurities, and this is also important property for the practical use for the gate-insulating materials. In the case of top-contact type TFT using poly(3-hexylthiophene) (P3HT) with PMSQ gate-insulating layer, the device properties were comparable with the TFTs having thermally grown SiO2 gate-insulating layer. The feasibility of PMSQ as a gate-insulating material for O-TFTs, which was fabricated on a flexible plastic substrate, has been demonstrated. Moreover, by the modification of PMSQ, further functionalities, such as surface hydrophobicity, high permittivity that allows low driving voltage, and photocurability that allows photolithography, could be appended to the PMSQ gate-insulating layers

A refractory cutaneous-rectovesical fistula complicated with abdominal actinomycosis successfully treated with antibiotic therapy

The patient was a 35-year-old Japanese man diagnosed with appendicitis with abscess formation. An appendectomy was performed, but a refractory surgical wound infection developed, and eventually a cutaneous-rectovesical fistula was detected. In a review of the first-time CT scan, a small high-density construction resembling a bone from a fish was detected in the ileum. The histopathological examination revealed granules of actinomyces. These findings suggested that abdominal actinomycosis due to intestinal mucosal breakage by the fish bone caused the secondary appendicitis, and that after the appendectomy, residual actinomyces caused the cutaneous-rectovesical fistula. After the diagnosis, total parenteral nutrition and a long-term administration of antibiotics improved the patient's clinical symptoms, and the fistula closed within a month. Antibiotics were administered for 6 months, and there has been no recurrence for 6-1/2 years. Because actinomycosis is difficult to diagnose based on the typical clinical features, a direct identification of the infecting organism from a tissue sample or from sulfur granules is required for the definitive diagnosis. Actinomyces is also known to cause fistula formation, and intestinal penetration caused by a fish bone may indicate abdominal actinomycosis. A rectovesical fistula requires surgical intervention in most cases, but in cases caused by abdominal actinomycosis, such a fistula may be cured by conservative therapy, as in our patient's case. It is important to consider the possibility of actinomycosis when a refractory rectovesical fistula is observed

Belly dancer syndrome improved by withdrawal of droxidopa and amantadine

Key Clinical Message A man hospitalized for cerebral infarction developed drug‐induced belly dancer syndrome, which improved after withdrawal of droxidopa and amantadine. Drugs that modulate dopamine neurotransmission have been reported to be associated with this syndrome. When belly dancer syndrome is suspected, clinicians should consider drug‐induced abdominal dyskinesia and medication withdrawal

Determination of Interface-State Distributions in Polymer-Based Metal-Insulator-Semiconductor Capacitors by Impedance Spectroscopy

Information on localized states at the interfaces of solution-processed organic semiconductors and polymer gate insulators is critical to the development of printable organic field-effect transistors (OFETs) with good electrical performance. This paper reports on the use of impedance spectroscopy to determine the energy distribution of the density of interface states in organic metal-insulator-semiconductor (MIS) capacitors based on poly(3-hexylthiophene) (P3HT) with three different polymer gate insulators, including polyimide, poly(4-vinylphenol), and poly(methylsilsesquioxane). The findings of the study indicate that the impedance characteristics of the P3HT MIS capacitors are strongly affected by patterning and thermal annealing of the organic semiconductor films. To extract the interface-state distributions from the conductance of the P3HT MIS capacitors, an equivalent circuit model with continuum trap states is used, which also takes the band-bending fluctuations into consideration. In addition, the relationship between the determined interface states and the electrical characteristics of P3HT-based OFETs is investigated

Well-differentiated Endocrine Cell Carcinoma of Ileum Treated by Laparoscopy-assisted Surgery : A Case Report

A 72-year-old woman presented at our hospital with a 1-year history of intermittent right lower abdominal pain. Colonoscopic examination revealed a submucosal tumor with a pitted surface in the terminal ileum. Histopathological diagnosis of the carcinoid tumor was made following biopsy. Blood serotonin and urine 5-hydroxy-indoleacetic acid levels were normal, and carcinoid syndrome was not detected. Enhanced abdominal computed tomography scan and 18F-fluorodeoxyglucose positron emission tomography failed to detect multiple lesions, lymph node swelling or distant metastasis. Laparoscopy-assisted ileocecal resection with lymph node dissection was performed. The resected specimen showed a submucosal tumor with a pitted surface 11 x 11 mm in size, located at the terminal ileum. Histopathological examination revealed a well-differentiated endocrine cell carcinoma with an invasion depth to the muscularis propria. Immunohistochemical analysis showed the tumor cells to be chromogranin A and CD56-positive. The patient had no sign of recurrence for 16 months