Surgical Strategy for Low Imperforate Anus in Girls -Cutback Anoplasty , Anal Transplantation or Limited Posterior Sagittal Anorectoplasty?-

From 1991 to 2001, we performed 5 re-operations with limited posterior sagittal anorectoplasty (PSARP) for low imperforate anus in girls who had anteriorly located anus after primary surgery. Four girls were diagnosed with anocutaneous fistula and one girl with anovestivular fistula. Primary operations were one cutback anoplasty and four anal transplantation. None of them underwent colostomies before re-operation with the limited PSARP. The sphincter muscle was cut through a median perineal skin incision and then the rectum was placed at the center of the complex muscles. This limited PSARP could give good anal function and satisfactory cosmetic appearanc

Serum Level of Hyaluronic Acid Does not Correlate with Changes of Hepatic Volume after Portal Vein Embolization

The serum hyaluronic acid (HA) levels are associated with liver regeneration after hepatectomy. In the present study, the HA concentrations were examined to evaluate the relationship with changes of hepatic volume after right portal vein embolization (PVE). The HA level of serum samples from 10 patients who underwent PVE before hepatectomy of the right lobe was measured, and the results were compared to the changed volume of embolized right lobe and unembolized left lobe of the liver. The mean serum HA level in patients with chronic viral liver disease (CVLD) (202+/-118 ng/ml) was significantly greater than in those without CVLD (70+/-24 ng/ml) (p<0.05). The volume of embolized liver decreased 72+/-96 CM3 (-8.9+/-5.5 %), while the volume of unembolized liver increased 106+/-67 CM3 (+8.9+/-5.5 %) 2 weeks after PVE. HA concentrations after 2 weeks of PVE (296+/-216 ng/ml) tended to be greater than that before PVE (134+/-108 ng/ml) but not statistically significant (p=0.105). There were no correlations between serum HA levels before PVE and the changes of hepatic volume in embolized and unembolized lobe after PVE. Our results indicate that the measurement of HA level is not useful for predicting the effect of PVE

Significant role of 1,25-dihydroxyvitamin D on serum calcium levels after total thyroidectomy: a prospective cohort study

IntroductionAlthough active vitamin D (VD) has been used both preoperatively and postoperatively to prevent hypocalcemia risk in patients undergoing total thyroidectomy, the role of 1,25-dihydroxyvitamin D (1,25(OH)2D) has not been examined. This study comprehensively investigated the effects of 1,25(OH)2D on calcium (Ca) concentrations after total thyroidectomy.MethodsSerum Ca, parathyroid hormone (PTH), and 1,25(OH)2D levels were measured in 82 patients with thyroid disease before and after surgery.ResultsSerum Ca, PTH, and 1,25(OH)2D levels decreased significantly on the morning of the first postoperative day. Notably, the decrease in 1,25(OH)2D concentration was significantly lower than that of PTH concentration (10.5 ± 33.4% vs. 52.1 ± 30.1%, p&lt;0.0001), with 28% of patients showing increases in 1,25(OH)2D. The only factor predicting a postoperative 1,25(OH)2D decrease was a high preoperative 1,25(OH)2D concentration. Postoperative 1,25(OH)2D concentrations, as well as the magnitude and rate of decrease from preoperative levels, showed strong positive correlations with preoperative 1,25(OH)2D concentrations (p&lt;0.0001 for all three variables) but not with PTH concentrations. These findings suggest that 1,25(OH)2D concentrations after thyroidectomy were more strongly dependent on preoperative concentrations than on the effect of PTH decrease and were relatively preserved, possibly preventing sudden severe postoperative hypocalcemia. A high 1,25(OH)2D level was the most important preoperative factor for hypocalcemia (&lt;2 mmol/L; p&lt;0.05) on the first postoperative day; however, only PTH decrease was statistically significant (p&lt;0.001) when intraoperative factors were added. In the PTH &gt;10 pg/mL group, the decrease in 1,25(OH)2D levels was significantly associated with postoperative hypocalcemia (p&lt;0.05). Similarly, in the PTH levels &gt;15 pg/mL group, a decrease in 1,25(OH)2D concentration was a significant factor, and the amount of PTH decrease was no longer significant.Conclusion1,25(OH)2D plays an important role in preventing sudden, severe hypocalcemia due to decreased PTH levels after total thyroidectomy, whereas high preoperative 1,25(OH)2D levels are a significant risk factor for postoperative hypocalcemia. Optimizing preoperative protocols to adjust Ca, PTH, and 1,25(OH)2D levels to improve the management of patients undergoing total thyroidectomy and to prevent extreme intraoperative PTH decreases may reduce the risk of hypocalcemia

Interferon regulatory factor-4 activates IL-2 and IL-4 promoters in cooperation with c-Rel.

Interferon regulatory factor (IRF)-4 is a member of the IRF transcription factor family, whose expression is primarily restricted to lymphoid and myeloid cells. In T-cells, IRF-4 expression is induced by T-cell receptor (TCR) cross-linking or treatment with phorbol-12-myristate-13-acetate (PMA)/Ionomycin, and IRF-4 is thought to be a critical factor for various functions of T-cells. To elucidate the IRF-4 functions in human adult T-cell leukemia virus type 1 (HTLV-1)-infected T-cells, which constitutively express IRF-4, we isolated IRF-4-binding proteins from T-cells, using a tandem affinity purification (TAP)-mass spectrometry strategy. Fourteen proteins were identified in the IRF-4-binding complex, including endogenous IRF-4 and the nuclear factor-kappaB (NF-κB) family member, c-Rel. The specific association of IRF-4 with c-Rel was confirmed by immunoprecipitation experiments, and IRF-4 was shown to enhance the c-Rel-dependent binding and activation of the interleukin-4 (IL-4) promoter region. We also demonstrated that IL-2 production was also enhanced by exogenously-expressed IRF-4 and c-Rel in the presence of P/I, in T-cells, and that the optimal IL-2 and IL-4 productions in vivo was IRF-4-dependent using IRF-4-/- mice. These data provide molecular evidence to support the clinical observation that elevated expression of c-Rel and IRF-4 is associated with the prognosis in adult T-cell leukemia/lymphoma (ATLL) patients, and present possible targets for future gene therapy

Surgical Strategy for Low Imperforate Anus in Girls -Cutback Anoplasty , Anal Transplantation or Limited Posterior Sagittal Anorectoplasty?-

From 1991 to 2001, we performed 5 re-operations with limited posterior sagittal anorectoplasty (PSARP) for low imperforate anus in girls who had anteriorly located anus after primary surgery. Four girls were diagnosed with anocutaneous fistula and one girl with anovestivular fistula. Primary operations were one cutback anoplasty and four anal transplantation. None of them underwent colostomies before re-operation with the limited PSARP. The sphincter muscle was cut through a median perineal skin incision and then the rectum was placed at the center of the complex muscles. This limited PSARP could give good anal function and satisfactory cosmetic appearanc