Double Congenital Fistulae with Aneurysm Diagnosed by Combining Imaging Modalities

Congenital coronary pulmonary artery fistula (CAF) is rare, and systemic-to-pulmonary artery fistula (SPAF) is even more so. Furthermore, congenital coronary pulmonary fistula associated with congenital SPAF is extremely rare. As far as we know, CAF and SPAF connected with an aneurysm have not been described very often. We described an 83-year-old woman with an aneurysm originating from a CAF connected to an aortopulmonary artery fistula. Chest radiography revealed a shadow at the left edge of the heart line. Multi-detector-row computed tomography (MDCT) with contrast enhancement and coronary cine angiography revealed that the shadow was an aneurysm connected to a tortuous fistula at the left anterior descending coronary artery. The aneurysm was formed by congenital coronary pulmonary and aortopulmonary artery fistulae. Echocardiography revealed predominantly systolic blood flow in the fistula from the left anterior descending coronary artery (LAD). Although neither MDCT, echocardiography nor coronary angiography alone could provide a comprehensive image of the anomaly, including the hemodynamics in the fistulae and their relationship with surrounding organs and tissues, their combination could provided important facts the led to a deeper understanding of this very uncommon occurrence

Myeloid-derived suppressor cells exacerbate poly(I:C)-induced lung inflammation in mice with renal injury and older mice

Viral pneumonia is a global health burden with a high mortality rate, especially in the elderly and in patients with underlying diseases. Recent studies have found that myeloid-derived suppressor cells (MDSCs) are abundant in these patient groups; however, their roles in the progression of viral pneumonia remain unclear. In this study, we observed a substantial increase in MDSCs in a mouse model of renal ischemia/reperfusion (I/R) injury and in older mice. When intranasal polyinosinic-polycytidylic acid (poly(I:C)) administration was used to mimic viral pneumonia, mice with renal I/R injury exhibited more severe lung inflammation than sham mice challenged with poly(I:C). In addition, MDSC depletion attenuated lung inflammation in mice with I/R injury. Similar results were obtained in older mice compared with those in young mice. Furthermore, adoptive transfer of in vitro-differentiated MDSCs exacerbated poly(I:C)-induced lung inflammation. Taken together, these experimental results suggest that the increased proportion of MDSCs in mice with renal I/R injury and in older mice exacerbates poly(I:C)-induced lung inflammation. These findings have important implications for the treatment and prevention of severe lung inflammation caused by viral pneumonia

Disappearance of pulmonary metastases by OK-432 treatment in a case of hepatocellular carcinoma.

We report here a case of hepatocellular carcinoma (HCC) with multiple lung metastases, which were disappeared by treatment of OK-432. The patient was a 65-year-old man and was diagnosed in 1986 with a small (17 x 11 mm) HCC in the anterior-superior segment of the liver. A part of the right hepatic lobe including the tumor was surgically removed, and transarterial injections of adriamycin (10 mg/week) and subcutaneous injections of OK-432 (10 KE/week) were given. Two and a half years later, recurrence of HCC in the liver and its invasion to vena cava inferior (IVC) were found. OK-432 administration was then stopped and percutaneous ethanol injection therapy (PEIT) was performed 10 times. Six months later, the PEIT was effective and the liver tumor with IVC invasion diminished. However, multiple lung metastases were visible on roentgenograms of the chest, and serum alphafetoprotein (AFP) concentration increased to 50,000 ng/ml. The OK-432 treatment resumed. After 6 months of OK-432 treatment, the multiple lung metastases were disappeared and the serum AFP level decreased to 100 ng/ml. At present, the patient is surviving without any sign of recurrence in either the liver or the lung. The clinical course of this case suggests that OK-432 might have effectively treated lung metastases of HCC, although the exact mechanisms are at present unclear.</p

<原著>神経外膜を利用した神経再建方法 : 神経断端の大きさが異なる場合の神経修復

We report a new method of nerve Reconstruction, wrap-around neurorrhaphy, in which the funicular suture site is wrapped with the epineurium of the larger stump. The specific applications of this procedure in brachial plexus reconstruction are described and the clinical results presented. The method was applied in intercostal nerve transfer to the musculocutaneous nerve in 21 patients and in 12 patients with axillary nerve injury who underwent reconstruction with autografts using wrap-around neurorrhaphy. Rigid fixation of the neurorrhaphy site could be obtained using this method, and the clinical results were satisfactory.神経再建にあたって, その縫合方法には神経外膜縫合, 神経周膜縫合, 神経外膜・周膜縫合などがある. 実際には神経の種類・部位・状態などによって, その縫合方法を変えているのが現状である. 神経外膜を温存・利用して, 神経再建した場所を包みこむ神経再建の方法(wrap-around neurorrhaphy)を記述し, その適用と臨床結果を発表したこの神経再建方法は, 神経周膜縫合部位の緊張を防止し, 神経束の整然とした包み込み(packing), そして強固な神経連結を目的とする. 神経断端の大きさが著しく異なる時の神経縫合, あるし、は関節可動威か大きくて縫合部位に緊張が推定される時の神経縫合には, この方法(大きい方の神経外膜で縫合部位を包む方法)の良い適用がある. この方法で神経を再建し, 術後2年以上経過している臨床症例の結果をまとめた. 症例は, 肋間神経移行術(互いの神経断端の大きさが著しく異なる例として)の21症例と, 版窟神経再建術(関節可動域が大きい場所での神経再建例として)の12症例である. 神経外膜を利用して, 神経縫合した場所を包みこむ神経再建方法は, このような症例にきわめて良好な適用かある

STM imaging of a model surface of Ru(4,4'-dicarboxy-2,2'-bipyridine)_2(NCS)_2 dye-sensitized TiO_2 photoelectrodes

A TiO_2(1 1 0)-(1 × 1) surface was prepared in an ultra-high vacuum, transported in laboratory air, and observed with a scanning tunneling microscope (STM) operated in a vacuum of 10^ Pa. Empty state images showed atomically flat terraces separated by single-height steps, on which 5-fold-coordinated surface Ti atoms were observed as spots arranged in a rectangular lattice. The Ru(4,4′-dicarboxy-2,2′-bipyridine)_2(NCS)_2 (N3) dye was adsorbed on the TiO_2 surface by immersing the TiO_2 wafer into an acetonitrile solution of the dye. In the empty state images, individual N3 molecules were observed as oval particles protruding by 0.6 nm from the TiO_2 surface. The oval shape elongated to the [11^^-0] directions was attributed to electron tunneling from tip to unoccupied states localized at the two carboxyl groups bound to the TiO_2 surface