Cytomegalovirus-associated biliary atresia

The pathogenesis of biliary atresia (BA) is propounded to be an immunological process, but the detailed mechanisms remain unclear. In recent studies with abnormal immunological findings, T cells have drawn attention in the mechanism of BA pathogenesis. Furthermore, cytomegalovirus (CMV) infection in BA patients resulted in elevated levels of helper T cells (Th1 and Th17) and reduction of regulatory T cells. Thus, CMV infection is considered as a cause of BA.We present the case of a 3-month-old boy who presented with intracerebral hemorrhage and finally died of liver failure. BA was diagnosed on autopsy and serum CMV-IgM was positive, but CMV antigen in the liver tissue was negative.Because CMV-associated BA has poor prognosis, compared with BA not associated with CMV, accurate classification of the type of BA is essential. Keywords: Biliary atresia, Cytomegalovirus, Cytomegalovirus-associated biliary atresi

Female pelvic organ‐preserving robot‐assisted simple cystectomy and intracorporeal ileal neobladder reconstruction on a young woman with Hunner‐type interstitial cystitis

Introduction Cystectomy is the last treatment option for Hunner‐type interstitial cystitis. However, consensus regarding optimal patient selection or treatment approaches is lacking. Case presentation A 27‐year‐old woman presented to a regional hospital with bladder pain and frequent urination. Antimicrobial therapy was administered; however, her symptoms persisted and she was finally diagnosed with HIC. Multiple endoscopic fulgurations of Hunner's lesions with bladder hydrodistension or intravesical therapy were performed; however, the symptoms persisted. A urethral catheter was inserted 1 month before she visited our clinic because of a severely contracted bladder. We performed female pelvic organ‐preserving robot‐assisted simple cystectomy and intracorporeal ileal neobladder reconstruction. The patient's postoperative course was uneventful and her symptoms resolved. Conclusion This is the first report of pelvic organ‐preserving robot‐assisted simple cystectomy and intracorporeal ileal neobladder reconstruction in a young woman with HIC

Relation between cigarette smoking and ventilatory threshold in the Japanese

The link between cigarette smoking and ventilatory threshold (VT) was investigated. We used data for 407 men and 418 women not taking medication. Habits of cigarette smoking were obtained through interviews by well-trained staff. The influence of cigarette smoking on oxygen uptake, work rate, and heart rate at VT was evaluated. Oxygen uptake at VT in women and work rate at VT in men with cigarette smoking were significantly lower than in subjects without cigarette smoking after adjusting for age. The differences of parameters at VT did not reach significant levels after adjusting for age and exercise habits in both sexes. However, in women without exercise habits, there was significant difference of oxygen uptake at VT between women with and without cigarette smoking after adjusting for age [cigarette smoking (+): 11.5 ± 1.8 ml/kg/min, cigarette smoking (−): 12.4 ± 2.1 ml/kg/min, p = 0.0006]. The number of cigarettes smoked per day and the Brinkman Index were not clearly correlated with oxygen uptake at VT. A combination of promoting exercise habits and prohibiting cigarette smoking might be recommended for improving the aerobic exercise level, especially in women