Determination of weathering rate of the Morro do Ferro Th-REEs deposit, Brazil using U-isotope method

The weathering rate was estimated by changes in (234)U/(238)U activity ratio (AR) and U content of rocks, borehole spoil and surface water samples at the Morro do Ferro Th-REEs deposit. The deposit is situated in the Poços de Caldas alkaline massif, Brazil. The south stream basin investigated in this paper has not been significantly affected by anthropogenic inputs of pollutants as compared to the Corumbataí River basin in São Paulo State, where the method was previously applied. The weathering rate derived utilizing the U-isotopes modeling corresponded to 0.015 mm/yr (67,000 years to weather 1m of rock under the actual climatic conditions). The estimated rate is very reasonable in comparison with the range of 0.015-0.05 mm/yr of land surface lowering within the entire caldera. It is also compatible with a rate of 0.013 mm/yr determined for the Salgado River basin in a semi-arid region in Bahia State, Brazil. The value generated is reliable and increases the potential use of the method for other different areas in Brazil and elsewhere, because it may be used in regions with different climatic conditions and (un)polluted basins.

Continuous low-dose human atrial natriuretic peptide promotes diuresis in oliguric patients after living donor liver transplantation

Human atrial natriuretic peptide (ANP) is beneficial for the prophylaxis of acute renal failure (ARF) after liver transplantation (OLT). We evaluated renal function in OLT patients with or without ARF, describing cases unresponsive to loop diuretics successfully treated with continuous low-dose ANP infusion without hemodialysis. Twenty-seven consecutive adult-to-adult living donor liver transplantations (LDLTs) were performed in 26 patients. One case was excluded due to the need for continuous hemodialysis (HD) during the operation. Of the 26 cases, 6 (23%, group 2) developed ARF in the first 30 days after LDLT; the other 20 were ARF-free (group 1). The median follow-up was 24 months. No patient required either continuous or intermittent HD. Only one patient died due to multiple liver abscesses. Mean preoperative serum creatinine (sCr) value and intraoperative blood loss in group 2 were significantly higher than those in group 1. Three cases in group 2 failed to improve on high-dose loop diuretics with low-dose dopamine, exhibiting fluid overload. The remaining three cases in group 2 responded to conventional diuretic treatments. Continuous low-dose ANP was started 2, 4, or 5 days after LDLT, and urine output significantly increased after ANP administration. The serum creatinine values were 1.1, 1.2, and 1.1 at 1 month and 1.0, 0.9, and 0.6 mg/dL at 6 months after LDLT. Massive blood loss during the operation caused ARF, but did not affect renal function after LDLT. Continuous low-dose ANP improved renal function and diuresis for oliguric ARF patients, preventing the need for HD or continuous venovenous hemodialysis.

Gastrointestinal stromal tumor mimicking gynecological disease

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors of the digestive tract. These tumors occasionally present a pelvic mass and leading to the misdiagnosis of gynecologic diseases. Two patients with GIST in the small intestine giving an impression of an ovarian fibroma and a uterine leiomyoma respectively were diagnosed correctly at the surgery. In the patients with a pelvic mass, especially if unusual symptoms and laboratory data being not compatible with gynecological disease, the possibility of diseases other than a gynecologic disease has to be considered.

Sporadic fetal heart rate decelerations associated with electrocortical changes in fetal lambs

AIM

The purpose of this study was to determine a relationship between sporadic fetal heart rate (FHR) decelerations and fetal electrocortical changes in physiologically normal sheep fetuses.

MATERIALS AND METHODS

A total of 20 experimental observations were conducted on eight chronically instrumented fetal lambs. For electrocorticogram (ECoG) recording, two stainless steel electrodes were implanted bilaterally on the fetal parietal skull. Classifications of ECoG tracings were visually divided into periods of low, high, intermediate and transitional voltage. During day and night observations, sporadic FHR decelerations related to fetal ECoG changes were counted.

RESULTS

We found that 65% of the total sporadic FHR decelerations occurred in relation to fetal ECoG changes. The largest number of sporadic FHR decelerations was associated with a switch from low voltage to high voltage ECoG (37%). However, the greatest frequency of sporadic FHR decelerations occurred during intermediate ECoG periods (34%).

CONCLUSION

The majority of sporadic FHR decelerations observed in physiologically normal sheep fetuses were associated with fetal ECoG changes.

Experience With Recipient’s Superficial Femoral Vein as Conduit for Middle Hepatic Vein Reconstruction in a Right-Lobe Living Donor Liver Transplant Procedure

Middle hepatic vein reconstruction during the right-lobe living donor liver transplant procedure has been recognized to be a significant factor. We initially reconstructed only a single middle hepatic vein orifice draining into segment 8. In cases where the right-lobe liver graft has several major middle hepatic vein tributaries, including veins draining segment 5 that are remote from the right hepatic vein orifice, a long and thick interposition conduit is necessary for reconstruction. Among 11 consecutive adult patients who received a right-lobe liver graft without a middle hepatic vein at our institution, 8 underwent reconstruction of all major middle hepatic vein tributaries using a vein graft from the recipient's superficial femoral vein. The remaining 3 patients had no major middle hepatic vein tributaries. Posttransplant-computed tomography imagings showed increased liver mass with a patent superficial femoral vein graft in 8 patients. In the absence of a venous system from a deceased donor, a recipient superficial femoral vein offers an excellent size match to maintain the venous outflow of middle hepatic vein tributaries. Reconstruction with recipient superficial femoral vein plays an important role in maximizing liver function and minimizing morbidity in the early posttransplant period.

Macrophage depletion prevents anti-graft antibody production and results in long-term survival in xenotransplantation

Liposome-encapsulated dichloromethylene diphosphonate (clodronate) is known to deplete macrophages. We examined the effect of clodronate on xenoreactive antibody production and xenograft rejection. Hamster cardiac grafts were transplanted into Lewis rats. Clodronate (4 mL/kg) was injected intravenously on the day before transplantation. In some groups, cyclosporine A (CsA) at a dose of 15 mg/kg was given daily intramuscularly until the end of each experiment. Untreated Lewis rats rejected the grafts at 2 and 3 days after transplantation. Neither CsA treatment alone nor clodronate treatment alone prolonged graft survival. Five of 7 Lewis recipients treated with clodronate and CsA did not reject hamster hearts for 100 days. Antibody production in the CsA plus clodronate-treated group was suppressed compared with control groups.

Effects of Exogenous Big Endothelin-1 on Regional Blood Flow in Fetal Lambs

OBJECTIVE

Endothelin-1, a 21 amino acid polypeptide produced by vascular endothelial cells, has potent vasoactive properties. The purpose of this study was to estimate the effects of exogenous big endothelin-1 on fetal lamb circulation.

METHODS

Regional blood flow was measured by the colored microsphere technique during continuous infusion (60 minutes) of big endothelin-1, or saline (control), in 12 chronically instrumented sheep fetuses.

RESULTS

After 60 minutes of big endothelin-1 administration, the fetal plasma endothelin-1 concentration increased significantly from 24.0 +/- 6.7 to 49.7 +/- 31.4 pg/mL (P = .018) without significant changes in fetal arterial blood gases. Continuous infusion of big endothelin-1 decreased blood flow in most organs except the brain and the heart. After the big endothelin-1 infusion, the blood flow to the brain significantly increased from 158 +/- 51 to 174 +/- 71 mL/min/100 g (P = .002); the blood flow to the heart also increased significantly from 171 +/- 95 to 200 +/- 112 mL/min/100 g (P = .001), respectively.

CONCLUSION

Continuous infusion of endothelin-1 decreases blood flow in most of organs except the brain and the heart. It is likely that endothelin-1 plays an important role in fetal redistribution of blood flow.

New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange

It is more difficult to control humoral rejection in living donor liver transplantations (LDLT) across the ABO blood group barrier than in matched or compatible combinations. We achieved excellent results in ABO-incompatible transplantation with novel immunosuppressive regimens and plasma exchange (PE). Among 82 LDLT were 10 cases of ABO-incompatible recipients, including three who were administered rituximab for rescue or prophylactic therapy. Pretransplantation PE was performed as necessary to maintain hemagglutinin titers below 1:16 and posttransplantation PE was performed when there were signs of hyperacute rejection associated with high titers. Induction immunosuppression consisted of FK506, steroid, mycophenolate mofetil (MMF), and rituximab. The first patient was administered rituximab with deoxyspergualin (DSG), steroid pulse therapy, and PE on postoperative day (POD) 7, because of biopsy-proven humoral acute rejection. The titers and LFTs improved drastically. The second and third patients were administered rituximab just after the operation with other routine immunosuppressants for prophylaxis of hyperacute rejection. The second patient showed a slight deterioration in LFTs with an elevated titer, which normalized after steroid pulse therapy and PE. The third patient had no episodes of rejection. At present, that is 27, 17, and 6 months after the operations respectively, the 3 transplant recipients are in stable condition.

A clinical study of Japanese patients with ulcer induced by low-dose aspirin and other non-steroidal anti-inflammatory drugs

BACKGROUND

The incidence and severity of non-steroidal anti-inflammatory drugs (NSAIDs)-induced gastro-duodenal ulcer have not been extensively studied in Japan.

AIM

We performed a prospective study to clarify NSAIDs-induced gastro-duodenal injury, focusing especially on low-dose aspirin (L-A).

METHODS

Two hundred and thirty-eight patients with bleeding peptic ulcers admitted to our hospital. History of taking NSAIDs and anti-ulcer drugs was obtained from all patients who underwent endoscopic examinations. The lesion scores of patients taking L-A were classified numerically from zero (no lesion) to five (ulcer).

RESULTS

The NSAIDs were associated with 28.2% of hemorrhagic ulcers. The rates of patients using L-A, loxoprofen, diclofenac, and combination of two of these drugs were 27, 16, 10 and 9%, respectively. Co-administered anti-ulcer drugs were cytoprotective anti-ulcer drugs (27%), H2 receptor antagonists (16%), PPI (4%), and none (53%). In patients taking L-A, H2 receptor antagonists were used most frequently. The HP was positive in 63% of L-A-induced ulcer cases and in 69% of NSAIDs other than low-dose aspirin-induced ulcer cases. The lesion scores of patients taking L-A with H2 receptor antagonists or PPI were significantly lower than those of patients who were taking only L-A (P < 0.05).

CONCLUSIONS

Approximately one-third of hospitalized patients with NSAIDs-induced hemorrhagic ulcer showed an association with L-A. Prospective randomized controlled trials including H2 receptor antagonists are required to establish preventive efforts aimed at L-A-induced gastro-duodenal injury.

Effect of Helicobacter pylori eradication on ongoing mutation of immunoglobulin genes in gastric MALT lymphoma

Gastric low-grade mucosa-associated lymphoid tissue (low-grade MALT) lymphomas has been associated with Helicobacter pylori (H. pylori) infection. Although infiltrating T cells with specificity for H. pylori are known to stimulate the development of MALT lymphomas, the effect of H. pylori eradication on rearranged immunoglobulin heavy chain (IgH) genes of low-grade gastric MALT lymphomas is unclear. Gastric biopsies from five cases were investigated by cloning and sequence analysis of rearranged IgH genes before and after the treatment for H. pylori. In all cases, IgH genes were mutated from their germline counterpart. The frequency of intraclonal sequence heterogeneity before the eradication of H. pylori varied from 0.25 to 0.49%. Clones obtained from the tumours before the eradication of H. pylori in cases 1 and 2 showed a tendency to display a mutation pattern by positive antigen selection and their monoclonarity disappeared after the eradication. The frequency of intraclonal sequence heterogeneity of the clones obtained from cases 3, 4 and 5 (0.12% in case 3, 0.10% in 4 and 0.18% in 5) after the eradication of H. pylori was lower than that in tumours before the eradication (0.30% in case 3, 0.49% in 4 and not determined in 5). These findings suggest that low-grade gastric MALT lymphomas expand due to the persistent presence of H. pylori in vivo. The characteristic feature of tumour clones obtained from the tumours after the eradication of H. pylori is a very low intraclonal heterogeneity, which may potentially be independent of H. pylori.

Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep

AIMS

To measure plasma concentrations of endothelin (ET)-1, NO metabolites (nitrate/nitrite; NOx) and 6-keto PGF1 alpha (PGF1 alpha) in maternal and fetal sheep blood, and to evaluate the effects of big ET-1 on hemodynamic response, blood gases and NO and 6-keto PGF1 alpha production in near term fetal sheep.

METHODS

Hemodynamic parameters were measured during infusion of big ET-1 into the carotid vein in chronically catheterized fetal sheep on day 125 of gestation. Fetal arterial blood samples were obtained for ET-1, PGF1 alpha) and nitrate/nitrite (NOx) measurements.

RESULTS

ET-1, NOx and PGF1 alpha plasma concentrations were all significantly higher in fetal compared with the maternal plasma. Big ET-1 significantly decreased fetal systolic and diastolic blood pressure and significantly increased fetal heart rate. Big ET-1 stimulated plasma PGF1 alpha), but not NOx , concentration.

CONCLUSIONS

Circulatory regulating factors in the fetus were up-regulated. The effects of ET-1 on fetal hemodynamic response may be mediated via prostacyclin, but not via the NO pathway.

Beneficial effect of FR183998, a Na+/H+ exchanger inhibitor, on porcine pancreas allotransplantation retrieved from non–heart-beating donors

Activation of Na(+)/H(+) exchanger (NHE) may have an important role in the ischemia/reperfusion injury by producing intracellular calcium overload. Recent studies have shown a beneficial effect of an NHE inhibitor on the ischemia/reperfusion injury in the heart. In this study, we examined the effect of FR183998, a potent NHE inhibitor, in porcine pancreas allotransplantation from non-heart-beating Landrace pig donors (NHBDs). The four experimental groups included: untreated with no preservation (group 1; n = 3), treated with no preservation (group 2; n = 5), untreated with preservation (group 3; n = 6), and treated with preservation (group 4; n = 4). The preservation was made in ice-cold University of Wisconsin (UW) solution for 24 hours. The groups treated received 1 mg/kg FR183998 before donor cardiac arrest and 10 mg in the UW solution flush in situ. Serum blood glucose, insulin, and amylase were measured daily. An intravenous glucose tolerance test (IVGTT) was performed on the postoperative day (POD) 7 when pigs were sacrificed for histological examination. Graft survival rates on that day in groups 1,2,3, and 4 were 3 of 3; 5 of 5; 3 of 6; and 4 of 4, respectively. The mean K values of IVGTT in groups 3 and 4 were 0.78 +/- 0.10 and 1.27 +/- 0.16, respectively, which were significantly different (P < .05). Upon histological examination, pancreatic tissue in group 3 showed more severe edema and necrosis than other groups. FR183998 may be considered beneficial for ischemia/reperfusion injury to pancreatic grafts from NHBDs.

The natural history of maternal immunization against foetal platelet alloantigens

Foetomaternal alloimmune thrombocytopenia (FMAIT) occurs when maternal antibodies of an antigen-negative mother cause destruction of sensitized foetal platelets. In Caucasian populations, 6-12% of human platelet antigen (HPA)-1a-negative women develop anti-HPA-1a, and the incidence of clinically affected cases is estimated to be 10-20% of immunized women. This study was performed in order to elucidate the rate of maternal immunization, incidence of FMAIT and the likely outcome of the condition in Asians. Excluding two or more pregnancies during the period, serum samples from 24 630 pregnant women, mainly Japanese, were screened for antibodies against platelet alloantigens by means of mixed passive haemagglutination (MPHA) (Anti-HPA-MPHA, Olympus, Tokyo). Antibodies were detected in 0.91% (223/24 630) of the women's samples and the immunization rate was correlated with the number of pregnancies. Antibody specificity included anti-HPA-4b (49), anti-HPA-5a (three), anti-HPA-5b (168), anti-HPA-4b + 5b (one) and anti-Nak(a) (CD36) (two). No alloimmunization was observed within the HPA-1, HPA-2, HPA-3 or HPA-6 systems. Among HPA-4b- or HPA-5b-negative women, 24% or 14% estimated, respectively, had antibodies and 26% (10/38) or 10% (12/125) of neonates, respectively, born to these mothers developed thrombocytopenia. Two neonates born to mothers having anti-HPA-4b developed generalized purpura. No cases of intracranial bleeding or death due to FMAIT were recorded. Generalized purpura due to FMAIT occurs in one in 9359 (95% CI: 1 in 77 519-1 in 2591) pregnancies solely because of HPA-4b incompatibility.

An omphalopagus parasitic twin after intracytoplasmic sperm injection

OBJECTIVE

To describe a first case of parasitic twin achieved after intracytoplasmic sperm injection (ICSI).

DESIGN

Case report.

SETTING

Perinatal center at a Japanese university hospital.

PATIENT(S)

A 30-year-old pregnant Japanese woman with a history of secondary infertility achieved after ICSI was diagnosed with an omphalopagus parasitic twin pregnancy by prenatal ultrasound at 28 weeks of gestation.

INTERVENTION(S)

A female infant was delivered by scheduled cesarean section at 30 weeks of gestation. The cesarean section was performed for dystocia.

MAIN OUTCOME MEASURE(S)

Brief review of parasitic twin and malformations in fetuses achieved after ICSI.

RESULT(S)

Resuscitation was not done because of the poor prognosis for both fetuses. Molecular analysis with informative genetic markers is consistent with monozygotic pregnancy.

CONCLUSION(S)

A careful ultrasound examination is indicated to detect additional anomalous findings in twin fetuses achieved after ICSI.

The effects of veno-venous extracorporeal membrane oxygenation on hypoxic fetal lambs

OBJECTIVE

The purpose of this study was to determine the applicability of veno-venous extracorporeal membrane oxygenation (V-V ECMO) to support fetal oxygenation in utero.

METHODS

An ECMO system with a centrifugal pump was applied to ten chronically instrumented fetal lambs, at 126 or 127 days of gestation. Blood was obtained through a double-lumen catheter inserted into the right atrium. After oxygenation, the blood was returned through a single-lumen catheter into either the carotid artery (veno-arterial; V-A ECMO) or the right atrium (V-V ECMO). After fetal hypoxia had been experimentally produced, V-A ECMO or V-V ECMO was instituted to maintain fetal oxygenation. We compared fetal blood gases with both routes of ECMO.

RESULTS

Oxygen partial pressure (pO(2)) in the fetal cranial carotid artery decreased to 12.9 +/- 0.6 mmHg after reducing the fraction inspiratory oxygen of the mother. After instituting V-A ECMO, pO(2) was found to be 23.5 +/- 2.6 mmHg; after instituting V-V ECMO, pO(2) was found to be 20.3 +/- 1.9 mmHg. Thus, fetal acidosis increased under both procedures. Fetal heart rate and blood pressure were not altered significantly during the experiments.

CONCLUSIONS

This study indicates that V-V ECMO could more effectively and less traumatically maintain oxygenation in hypoxic fetal lambs.

Imprint cytology of extraskeletal mesenchymal chondrosarcoma of the perineum: a case report

BACKGROUND

Extraskeletal mesenchymal chondrosarcoma (EMC) is an uncommon soft tissue tumor, occurring mainly in the lower limbs, meninges and retroperitoneum. EMC of the female genital tract is extremely rare, and the cytologic literature is scarce.

CASE

A 43-year-old female with a growing perineal mass underwent excision of the tumor. Pathologic examination of the rumor revealed a characteristic two-cell pattern of primitive small cells and cartilaginous tissue. A diagnosis of EMC of the perineum was made. Imprint cytology from surgical material showed a cluster of small round cells with a focal hemangiopericytomalike arrangement and islets of cartilage. The cartilaginous cells reacted with S-100 protein immunocytochemically.

CONCLUSION

The characteristic features of EMC, a hemangiopericytomalike arrangement of small cells and S-100-positive cartilaginous cells, may be helpful in diagnosing EMC and differentiating it from other perineal tumors.

The Effect of Magnesium Sulfate on the Behavioral Activities of Fetal Goats

OBJECTIVES

To investigate fetal heart rate accelerations, fetal breathing movements, and fetal electrocortical activities during administration of magnesium sulfate to fetal goats.

METHODS

The fetal heart rate accelerations, fetal breathing movements, and fetal electrocortical activities during 6 hours of continuous magnesium sulfate infusion into the fetal jugular vein were examined in 8 chronically instrumented fetal goats at 124-131 days of gestation. Fetal breathing movements were defined as repetitive negative fluctuations of the fetal tracheal pressure. Fetal electrocortical activities were assessed by visual analysis of periods of high-voltage and low-voltage electrocortical activities.

RESULTS

Continuous infusion of magnesium sulfate for 6 hours significantly increased the fetal plasma magnesium concentration from 2.8 +/- 1.2 to 8.3 +/- 2.6 mg/dL without significant changes in fetal arterial blood gases. The incidence of fetal heart rate accelerations during magnesium infusion was significantly decreased from that found during the control periods. After 2 hours of infusion, the incidence of fetal breathing movements significantly decreased from 33.9% +/- 20.5% to 1.2% +/- 1.4% and remained at this level during the remaining 4 hours of magnesium infusion. The percentage of time that the fetuses were found to have low-voltage electrocortical activities decreased from 51.6% +/- 9.0% to 40.4% +/- 8.2% after 2 hours of infusion but recovered to 49.9% +/- 12.0% by 6 hours of magnesium infusion.

CONCLUSION

We concluded that fetal magnesium sulfate administration affected fetal heart rate accelerations and fetal breathing movements continuously but electrocortical activities only temporarily during 6 hours of observations.

Prenatal diagnosis for placental steroid salfatase deficiency with fluorescence in situ hybridization: A case of X-linked ichthyosis

X-linked ichthyosis (XLI) is a relatively common genetic disorder that occurs in about one in every 2000-6000 male births. Clinically, XLI is characterized by a generalized scaling of the skin, with large, polygonal, dark brown scale, and more prominent on the extensor aspects of the limbs. It is known that an undetectable maternal serum, unconjugated estriol, associated with placental steroid sulfatase (STS) deficiency, may be the cause of cause of XLI. In most case, STS deficiency is caused by a complete or partial deletion of the STS gene mapped on chromosome Xp22.3. We describe here the prenatal detection of a male fetus affected with STS deficiency as a result of an undetectable unconjugated estriol in the second-trimester maternal serum screening. Microdeletion of the STS gene was confirmed by fluorescence in situ hybridization analysis of cultured amniotic fluid.

Fetal hepatic hemangioma representing non-reassuring pattern in fetal heart rate monitoring

To the best of our knowledge, this is the first report of a non-reassuring fetal pattern caused by a hepatic hemangioma that was found during fetal heart rate monitoring. A 37 weeks' gestation, a 32-year-old-woman was referred to our hospital for evaluation of a rapidly growing fetal abdominal tumor. Fetal heart rate monitoring revealed a non-reassuring pattern, and a cesarean section was performed as a result. Examination of the 2820 g female infant suggested a hepatic hemangioma accompanying an intratumor hemorrhage and coagulopathy. The infant died 2 days after birth. The autopsy confirmed that the cause of death was a result of a hepatic hemangioma. Frequent monitoring of fetuses and ultrasound examinations are necessary for determining the timing of delivery and for a favorable prognosis.