Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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We report 2 cases of ruptured aneurysms of the posterior inferior cerebellar artery associated with an arteriovenous malformation (AVM). The aneurysm and AVM were simultaneously embolized with n-butyl cyanoacrylate. ⋯ In both cases the aneurysms were successfully occluded. The effectiveness and limitations of this treatment are discussed.
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Congenital cytomegalovirus (CMV) infection can cause severe permanent disabilities. A mother who is seronegative before conception but acquires infection during pregnancy is a risk factor for congenital infection. We describe a neonate in whom congenital CMV infection was diagnosed at birth and confirmed with DNA quantitation by means of the polymerase chain reaction, was accompanied by cerebral ventriculomegaly and severe hearing loss, and was treated with ganciclovir/valganciclovir for 6 weeks. ⋯ Single-photon emission computed tomography showed marked improvement 6 months after treatment. This case provides compelling evidence that a reliable diagnosis of congenital CMV infections coupled with a prompt and appropriate treatment program can prevent permanent disability. It is, therefore, important to establish a more effective strategy for the management of congenital CMV infection.
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Case Reports
Two cases of flexor digitorum profundus avulsion due to enchondroma of the distal phalanx.
Avulsion of the flexor digitorum profundus tendon with fracture of the distal phalanx is rare. Moreover, enchondroma is less frequent in the distal phalanx. We report two unusual cases of avulsion of the flexor digitorum profundus tendon at its insertion in combination with pathological fracture of the distal phalanx due to enchondroma. ⋯ At the final follow-up examinations, there were no symptoms and no recurrence of the bone tumor. In the present cases, three-dimensional computed tomography imaging was useful for diagnosing the flexor tendon avulsion, determining the preoperative identification the location of a ruptured tendon stump, and planning the operation to minimize the surgical wound. The recommended treatment for avulsion of the FDP tendon due to enchondroma is curettage, bone grafting of the resultant cavity, and reattachment of the tendon to ensure sufficient structural strength to permit secure fixation and early mobilization and, especially, to prevent flexion contracture of the finger because the stump of the flexor digitorum profundus is buried in the cavity of the distal phalanx.
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Like other forms of laparoscopic surgery, laparoscopic pancreaticoduodenectomy (Lap-PD) is a minimally invasive procedure that can greatly reduce bleeding during surgery. We performed Lap-PD for a case of intraductal papillary mucinous neoplasm. To remove the resected tissue from the body, we made a small incision directly above the line of transection of the distal pancreas (the cut stump). ⋯ All reconstructive procedures, except for hepaticojejunostomy, were performed under direct visualization; hepaticojejunostomy was performed laparoscopically. The reconstructive surgery was effective and was as safe as open abdominal surgery. We also discuss the value of using an endoscopic linear stapler for Lap-PD pancreatic transection, to reduce extravasation of pancreatic fluid into the abdominal cavity during the resection of tumors involving the pancreatic ducts, such as intraductal papillary mucinous neoplasm.
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Myofibroblasts play a critical role in tissue fibrosis. However, the intracellular signaling pathways in myofibroblast differentiation are poorly understood. Here, we studied the relationship between transforming growth factor-β (TGF-β)/Smad pathway activation and myofibroblast differentiation in both in vivo and in vitro experiments. ⋯ However, TGF-β1 produced no effect on the quantity of ASMA, either in mRNA levels or protein levels, even after the phosphorylation of Smad2/3. In contrast, TGF-β1 upregulated the expression of type I collagen mRNA. These findings suggest that in pulmonary fibrosis the molecular mechanism of myofibroblast differentiation is complex and that the difference between ASMA expression and type I collagen expression is mediated by the TGF-β/Smad pathway.