Malignant bladder pheochromocytoma with SDHB genetic mutation

A 30-year-old man presented with micturition pain and was diagnosed with a submucosal tumor in the right wall of the bladder with metastasis to the right obturator lymph node. Transurethral resection led to a diagnosis of invasive malignant pheochromocytoma. Radical cystectomy, neobladder reconstruction and bilateral iliac lymph node dissection were performed. Genetic analysis revealed succinate dehydrogenase B-associated hereditary pheochromocytoma/paraganglioma syndrome. 10 months after the operation, he had no evidence of recurrence.

Photon-induced positron annihilation lifetime spectroscopy using ultrashort laser-Compton-scattered gamma-ray pulses

High-energy ultrashort gamma-ray pulses can be generated via laser Compton scattering with 90° collisions at the UVSOR-II electron storage ring. As an applied study of ultrashort gamma-ray pulses, a new photon-induced positron annihilation lifetime spectroscopy approach has been developed. Ultrashort gamma-ray pulses with a maximum energy of 6.6 MeV and pulse width of 2.2 ps created positrons throughout bulk lead via pair production. Annihilation gamma rays were detected by a BaF2 scintillator mounted on a photomultiplier tube. A positron lifetime spectrum was obtained by measuring the time difference between the RF frequency of the electron storage ring and the detection time of the annihilation gamma rays. We calculated the response of the BaF2 scintillator and the time jitter caused by the variation in the total path length of the ultrashort gamma-ray pulses, annihilation gamma rays, and scintillation light using a Monte Carlo simulation code. The positron lifetime for bulk lead was successfully measured.

Total removal of huge chondrosarcoma of the skull base with facial nerve resection and reconstruction

Chondrosarcomas of the skull base are locally aggressive tumours, and radical surgical resection is often difficult because of involvement of important neural structures in the skull base. We report the successful total resection of a huge skull base chondrosarcoma extending both intra- and extracranially. The tumour involved the left mastoid process, entire petrous bone, jugular foramen, posterior fossa and the parapharyngeal space. Since the facial nerve in the fallopian canal was totally involved by the tumour, the nerve was sacrificed and reconstructed using a great auricular nerve graft. The removal of the tumour was radical and complete. The functional recovery of the reconstructed facial nerve was excellent. The patient has almost fully recovered from the other neurological symptoms and has been free of tumour recurrence for 4 years after surgery.

A scoring system for the assessment of angiographic findings in non-occlusive mesenteric ischemia (NOMI)

PURPOSE

To establish a standardized scoring system for angiographic findings in patients with non-occlusive mesenteric ischemia (NOMI).

MATERIALS AND METHODS

In 36 patients (mean age: 72 years), 53 angiographies of the superior mesenteric artery (SMA) were performed for suspected NOMI after cardiac or major aortic surgery. All examinations were performed using a standardized DSA technique. Two experienced radiologists performed a consensus reading blinded to the clinical information, on two occasions with an interval of two weeks. In order to investigate the reproducibility of the criteria, the images were assessed once by an intensivist and a medical student. Image analysis was performed with respect to vessel morphology, reflux of contrast medium into the aorta, small bowel parenchymal contrast enhancement and distension and the delay between arterial injection and portal vein filling.

RESULTS

Almost perfect intra-observer correlation was obtained for the assessment of the contrast medium reflux (κ = 0.82) and substantial correlation for the time of portal vein filling (κ = 0.66). Moderate correlations were obtained for the vessel morphology (κ = 0.51), small bowel enhancement (κ = 0.63) and distension (κ = 0.53). Contrast medium reflux into the aorta (κ = 0.77 and 0.63) and the time of portal vein filling (κ = 0.42 and 0.58) resulted in the highest inter-observer correlations between the radiologists and the intensivist as well as the radiologists and the student.

CONCLUSION

In patients with suspected NOMI, using our scoring system yields high intra- and inter-observer correlations, allowing a standardized evaluation of angiographic findings.

Pressure pain threshold of mucosa after tooth extraction under removable denture bases

This study explored the pressure pain threshold (PPT) of the mucosa after tooth extraction. The PPTs of the wounded mucosa of eight volunteer subjects were observed at 7, 30, and 90 days after tooth extraction. The PPTs at 30 days and 90 days were approximately two and three times higher respectively, than those at 7 days. As time passed, the values for the PPTs after tooth extraction increased in all regions. At 90 days after tooth extraction, the PPTs are about 97% recovered compared to the PPTs of the contralateral points.

Effect of linoleic acid albumin in a dilution solution and long-term equilibration for freezing of bovine spermatozoa with poor freezability

Despite normal eucrasia, mating desire and semen quality, sire bulls sometimes have spermatozoa with poor freezing tolerance. This study assessed effects of the addition of linoleic acid albumin (LAA) and long-term (LT) equilibrium to frozen semen on their sperm freezing tolerance. Immediately after collection using an artificial vagina and a breeding mount, semen was diluted with yolk citrate buffer; then, it was cooled slowly to 4°C during more than 5 h. Equilibrium treatment at 4°C was applied using the same extender supplemented with glycerol. Semen of bull A, with low sperm freezing tolerance, was treated with 1 mg/ml of LAA added to the first extender. The equilibrium treatment at 4°C was prolonged to 30 h. Significantly higher motility rates were obtained for the LT + LAA-treated sperm before and after freezing-thawing. However, for semen of bulls B and C with normal sperm freezing tolerance, the LT + LAA treatment barely exhibited a small effect on the motility rate. Almost no difference was found among bulls A, B and C in the motility rates of LT + LAA-treated sperm after freezing-thawing. No difference of fertility was apparent on LT + LAA-treated frozen sperm in comparison with normal sperm in embryonic collection and in vitro fertilization. It was not an aberration of fertility in vivo or in vitro. In addition, the conception rate of artificial insemination did not have a difference, and a normal calf was obtained. Results show that addition of LAA to an extender for frozen bovine spermatozoa and 30 h of low-temperature equilibrium might improve the motility of freezing-thawing spermatozoa with poor freezability. Sperm exhibited normal fertilization capability and ontogenic capability.

Subintimal revascularization of chronic iliac artery occlusions using a reentry-catheter

PURPOSE

To demonstrate the value of a Reentry-Catheter for true lumen access after subintimal revascularization of chronic iliac artery occlusions.

MATERIALS AND METHODS

Subintimal revascularization was performed in 5 patients (mean age: 67 ± 12 years; female: 3, male: 2) with total iliac artery occlusion (TASC B to D), but without gaining access to the true lumen distal to the occlusion. Subsequently, a Reentry-Catheter was used to establish reentry and a new subintimal tract. Patients were followed up after 6, 12 and 24 months for clinical re-evaluation to determine the Rutherford score and the ankle brachial index (ABI). In addition, duplex ultrasound was performed to evaluate vessel patency.

RESULTS

The primary technical success rate was 100 %. In all cases angioplasty was followed by stent placement to establish the subintimal tract. The mean Rutherford score decreased from 3.6 ± 0.9 to 0.33 ± 0.57 after 24 months, while the ABI increased from 0.67 ± 0.06 to 1.2 ± 0. Vessel patency was observed in all patients available for follow-up examinations.

CONCLUSION

The Reentry-Catheter reliably allowed access to the true lumen after subintimal revascularization of occluded iliac arteries. Results in this small patient cohort showed a significant reduction in the Rutherford score, increase in the ABI, and a good patency rate after two years.

Refined human artificial chromosome vectors for gene therapy and animal transgenesis

Human artificial chromosomes (HACs) have several advantages as gene therapy vectors, including stable episomal maintenance, and the ability to carry large gene inserts. We previously developed HAC vectors from the normal human chromosomes using a chromosome engineering technique. However, endogenous genes were remained in these HACs, limiting their therapeutic applications. In this study, we refined a HAC vector without endogenous genes from human chromosome 21 in homologous recombination-proficient chicken DT40 cells. The HAC was physically characterized using a transformation-associated recombination (TAR) cloning strategy followed by sequencing of TAR-bacterial artificial chromosome clones. No endogenous genes were remained in the HAC. We demonstrated that any desired gene can be cloned into the HAC using the Cre-loxP system in Chinese hamster ovary cells, or a homologous recombination system in DT40 cells. The HAC can be efficiently transferred to other type of cells including mouse ES cells via microcell-mediated chromosome transfer. The transferred HAC was stably maintained in vitro and in vivo. Furthermore, tumor cells containing a HAC carrying the suicide gene, herpes simplex virus thymidine kinase (HSV-TK), were selectively killed by ganciclovir in vitro and in vivo. Thus, this novel HAC vector may be useful not only for gene and cell therapy, but also for animal transgenesis.

[Multimodal approach in coincidence of covered ruptured abdominal aortic aneurysm and aortocaval fistula]

HISTORY AND ADMISSION FINDINGS

A 71-year-old patient had been referred to our hospital with the diagnosis, made by angio-computed tomography (CTA), of a covered ruptured abdominal aortic aneurysm (AAA) resulting in an aortocaval fistula (ACF).

INVESTIGATIONS

The physical examination revealed macrohematuria and high-output heart failure with increasing circulatory insufficiency.

DIAGNOSIS, TREATMENT AND COURSE

An open endovascular procedure was not possible because the AAA had extended into both internal iliac arteries. A bifurcated prosthesis connecting to both femoral arteries was then successfully implanted and the infrahepatic aortocaval fistula closed by a patch through the AAA. Ischemic colitis, diagnosed on postoperative day 2 (POD 2), was successfully treated with antibiotics. CTA, done on POD 5, revealed a small residual ACF, filling retrogradely from the right external iliac artery via the surgically closed aneurysmal sack. Closure of the residual ACF was achieved with an Amplatz occluder inserted into the right external iliac artery, introduced percutaneously via the right femoral artery. The postoperative course was uneventful and the patient discharged on POD 13.

CONCLUSION

The coincidence of AAA and ACF is rare. However, the morbidity and mortality are high and require early diagnosis and immediate treatment.

[MR imaging of lymph nodes using Gadofluorine M: feasibility in a swine model at 1.5 and 3T]

PURPOSE

To investigate the potential of Gadofluorine M for targeted lymph node imaging in a human size animal model and on a clinical MR scanner at 1.5 and 3 T.

MATERIALS AND METHODS

Pelvic and cervical lymph nodes in a swine model were investigated prior to and 24 hours after intravenous administration of 50 micromol/kg body weight Gadofluorine M, an experimental contrast agent. MR imaging was carried out on clinical 1.5 T and 3 T whole-body MR systems using clinically available coils and T 1-weighted sequences. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with respect to the surrounding tissue were assessed and compared using the Student's t-test. The Gd concentration in the lymph nodes (n = 43) was measured post mortem by Inductively Coupled Plasma-Atomic Emission Spectroscopy (ICP-AES).

RESULTS

Gadofluorine M allowed for high signal and high contrast visualization of lymph nodes in all stations on post-contrast images with a significantly increased SNR and CNR (SNR pelvic lymph nodes post vs. pre: 46 +/- 7 vs.14 +/- 3, SNR cervical lymph nodes post vs. pre: 105 +/- 64 vs. 32 +/- 21; CNR pelvic lymph node vs. muscle post vs. pre 28 +/- 5 vs. 0.2 +/- 0.5, CNR cervical lymph node vs. muscle post vs. pre 76 +/- 53 vs. 11 +/- 15, p < 0.05 for all comparisons). The SNR and CNR in the pelvis were further improved using 3 T compared to 1.5 T scanners (SNR lymph nodes 3 T vs. 1.5 T 84 +/- 6 vs. 46 +/- 7, CNR lymph node vs. muscle 3 T vs. 1.5 T 53 +/- 9 vs. 28 +/- 5 respectively, p < 0.05). A high concentration of Gd in the lymph nodes was found (149 +/- 25 mmol Gd/L).

CONCLUSION

Gadofluorine M accumulates in the lymph nodes and allows for selective targeted high contrast MR imaging of lymph node tissue in a large animal model using clinically available MR imaging techniques. 3 T further improves SNR and CNR compared to 1.5 T.