A case of adrenocortical adenoma containing small adipose foci is presented. A small amount of fat within the mass led to an erroneous preoperative diagnosis of myelolipoma. Adrenal adenoma should be included in the differential diagnosis of adrenal mass containing fat.

Adipose Tissue↗

PubMedDate not supplied

Aortic dissection after previous coronary artery bypass grafting.

Aortic dissection after coronary artery bypass grafting (CABG) is a rare but potentially fatal complication. The aim of this study was to identify the reasons. Between 1991 and 2000 in our institution CABG was performed on 22,732 patients. In the same time interval 12 (0.5 degree/00) patients presented with an aortic dissection after previous CABG. Age: 59.1 +/- 5.9 years, gender: 10/2, only Stanford A dissections, 4 chronic and 8 acute dissections, mortality: 3, all acute. 2 died of cardiac complications (left heart failure), 1 of other complications (gastrointestinal ischemia). The time interval between CABG and dissection was 2.5 +/- 3.6 years. Two dissections were intraoperative, another 5 were within the first year; the longest time interval was 10 years. In 5 cases the entry originated from a central anastomosis, 1 originated from the aortic cannulation site, and 1 from the site of the cross clamping. In 5 cases the entry was not directly related to the previous operation (1 was located in close proximity to the left coronary ostium, 2 between aortic valve annulus and the coronary ostia and 2 between the distal coronary arteries in the ascending aorta). Pathological changes of the aorta were not described at the time of CABG; only in 1 case a mild aortic regurgitation and dilatation (47 mm) at the time of the first operation was described. As our results suggest an aortic dissection presenting after CABG must be considered to be a rare complication of the previous operation. Considering the severity of this complication satisfying results can be achieved.

Aortic Dissection↗

PubMedDate not supplied

Struma ovarii: MR findings.

PURPOSE: The purpose of this study was to determine the MR appearance of struma ovarii correlating with the pathological features. METHOD: MR findings of two patients with struma ovarii were retrospectively reviewed and compared with the pathological findings. RESULTS: Both tumors were complex masses composed of multiple cysts and solid components. The size and signal intensity of multiple cysts varied within the tumor. Hyperintense cystic areas on T1-weighted images were thought to correspond pathologically to hemorrhagic cysts and follicles containing viscous proteinaceous colloid. Solid components had as high a signal intensity as did uterine endometrium on T2-weighted images and as intermediate a signal intensity as did uterine muscle layer on T1-weighted images. After intravenous administration of gadolinium-DTPA, the solid components showed marked contrast enhancement. There was also ascitic fluid associated with adhesion and peritoneal thickening. CONCLUSION: The characteristic MR appearance of struma ovarii is thought to be a mixed mass composed of T2-hyperintense solid components with intense contrast enhancement and multiple T1-hyperintense cystic areas suggestive of hemorrhagic degeneration and viscous proteinaceous colloid.

Adult↗

PubMedDate not supplied

CT and MR findings of posterior mediastinal panniculitis.

A case of posterior mediastinal panniculitis is reported. CT and MRI showed a paraspinal mass containing a small amount of fat. The intercostal veins were found to run through the mass without being distorted, mimicking lymphoma. The diagnosis of panniculitis was made by CT-guided biopsy and open biopsy.

Humans↗

PubMedDate not supplied

Epidemiologic study of Chlamydia trachomatis infection in pregnant women.

GOAL OF THE STUDY: The presence of Chlamydia trachomatis in the cervical canal was investigated in 10,980 married pregnant women and 1,792 unmarried pregnant women who underwent artificial abortions in Hokkaido. STUDY DESIGN: Cervical canal smears were screened for C. trachomatis in pregnant patients. RESULTS: In the married women, the detection rate of C. trachomatis was 5.6% (615 of 10,980 cases). In the unmarried women, the detection rate of C. trachomatis was 15.2% (272 of 1,792 cases). Stratification of the data on the detection of C. trachomatis as a function of the subjects' age showed that, for both the married and the unmarried women, the detection rate increased as the age of the subjects decreased. Analysis of the detection rate of C. trachomatis as a function of the year revealed that it had not changed since 1986. CONCLUSIONS: The findings in this study show that there has been an epidemic of asymptomatic C. trachomatis infections in Hokkaido, especially in young women.

Adult↗

PubMedDate not supplied

Heart transplantation in children after mechanical circulatory support: comparison of heart transplantation with ventricular assist devices and elective heart transplantation.

Heart transplantation (HTx) is an ultimate treatment for children with end-stage heart failure or inoperable congenital heart disease. The supply of hearts is inadequate; therefore, different mechanical support systems must be used as bridge to HTx in pediatric patients with postoperative low output. The use of ventricular assist devices (VADs) as bridge to HTx in children is limited because of size differences. The purpose of this study was to evaluate the overall long-term outcome of pediatric circulatory support before pediatric HTx. From 1989 through 2004, 91 pediatric patients underwent isolated HTx. Seven of them required mechanical support before transplantation. We reviewed retrospectively the course of 91 children (mean age 14.7 years) who underwent HTx. Group A consisted of elective HTx patients who were treated as outpatients before HTx, whereas group B was the VAD-HTx bridging group (n=7; mean age 12.31 +/- 2.8 years). Mean duration of VAD support was 108 +/- 98 days (minimum 1 day, maximum 258 days). Overall survival rate after HTx was 80% at 1 year without significant differences between groups. Five of seven patients survived and could be discharged after successful HTx, for a survival rate of 77%. The mean follow-up period was 16.76 +/- 10.6 months. No differences in posttransplantation long-term survival and rejection episodes occurred between patients transplanted with or without VAD. VAD therapy can keep pediatric patients with end-stage heart failure alive until successful HTx, and bridge to HTx is a safe procedure in pediatric patients. After HTx, survival rates of these children are similar to those of patients awaiting elective HTx.

Adolescent↗

PubMedDate not supplied

Acute transverse myelitis caused by Coxsackie virus B5 infection.

A 6-year-old boy developed symptoms of rapidly progressive paraplegia, associated with bowel and urinary dysfunction, but without sensory loss. Magnetic resonance imaging (MRI) examination showed diffuse swelling of the lower spinal cord on T1-weighted images. Based on the clinical presentation and MRI findings, a diagnosis of acute transverse myelitis was made. The serum titer of neutralizing antibody against Coxsackie virus B5 rose from 1/4 on admission to 1/256 1 month later and Coxsackie virus B5 was isolated from stool samples. This case serves as a reminder that acute transverse myelitis can be a rare clinical manifestation of Coxsackie virus B5 infection.

Antibodies, Viral↗

PubMedDate not supplied

beta2-adrenergic receptor stimulation-induced immunosuppressive effects possibly through down-regulation of co-stimulatory molecules, ICAM-1, CD40 and CD14 on monocytes.

We examined the effects of beta2-adrenergic receptor (beta2-AR) agonists on the expression of co-stimulatory molecules on lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells. The study found that beta2-AR agonists inhibited the expression of intercellular adhesion molecule-1 (ICAM-1), CD40 and CD14 on monocytes, and that AR agonist activity was antagonized by the selective beta2-AR antagonist, butoxamine. The selective beta2-AR agonists salbutamol and terbutaline induced a similar co-stimulatory molecule expression pattern. The LPS-induced production of tumour necrosis factor-alpha was inhibited by AR agonists, and this was also antagonized by butoxamine, and mimicked by salbutamol and terbutaline. The AR agonists also inhibited T-cell proliferation through beta2-AR stimulation. This study clearly demonstrated that endogenous catecholamines elicited immunosuppressive effects through beta2-AR stimulation, possibly due to down-regulation of the expression of ICAM-1, CD40 and CD14 on monocytes. These results suggested that the sympathetic nervous system might regulate the T-helper cell balance via the peripheral end-effectors of the stress system.

Adrenergic beta-2 Receptor Agonists↗

PubMedDate not supplied

Laterality effects for tactile patterns.

A series of studies was carried out to investigate laterality effects in the discrimination of tactile patterns presented to the fingertips of right-handed subjects. When both hands were stimulated simultaneously, a small right-hand advantage (RHA) was observed for a sequential task and a small left-hand advantage (LHA) was found for a spatial task, but only in women and only when there was a delay or mask between presentation and response. This may indicate different attentional strategies for men and women, or better shielding against interhemispheric interference in women. When only one hand was stimulated at a time (unimanual tasks), no laterality effects were found with sequential tasks, but a substantial RHA for a spatial task was observed. Because the unimanual spatial task involves more possible alternatives than the unimanual sequential ones, this RHA may be a consequence of increased information load rather than a the spatial/sequential distinction. While laterality effects in tactile laterality studies are relatively inconsistent, there are clear differences between bimanual and unimanual presentation. Effects related to hemispheric specialization are much more evident with bilateral presentation.

Female↗

PubMedDate not supplied

Dysregulation of telomerase activity and expression in lymphokine-activated killer cells from advanced cancer patients: possible involvement in cancer-associated immunosuppression mechanism.

There exists cancer-associated immunosuppression, and the generation of lymphokine-activated killer (LAK) cells is impaired in patients with advanced cancer. Telomerase has been reported to be upregulated in the activation of lymphocytes to proliferate against immune stimulation as well as in the malignant transformation of immortal cancer cells. We attempted to clarify the involvement of telomerase in the impairment of LAK cell generation in patients with advanced cancer. LAK cells were generated by stimulation with interleukin (IL)-2 and immobilized anti-CD3 antibody (IL-2/CD3 system) from peripheral blood mononuclear cells of healthy volunteers (he-LAK) or patients with advanced cancer (ca-LAK), and proliferative potential of LAK cells was evaluated on the basis of population doubling level (PDL). Telomere length and telomerase activity of LAK cells were measured by the hybridization with oligonucleotide (TTAGGG)4 and by the telomeric repeat amplification protocol (TRAP) assay, respectively. Effects on telomerase activity in LAK cells of serum from cancer patients, transforming growth factor (TGF)-beta, and IL-10 were also examined. The lifespan of ca-LAK (15.2 +/- 5.1 PDLs) was significantly shorter than that of he-LAK (22.6 +/- 8.3 PDLs) (p = 0.0358). There were no significant differences between he- and ca-LAK in telomere length before IL-2/CD3 stimulation and maximal telomerase activity induced. The telomerase activity induced in ca-LAK failed to elongate sufficiently the telomeric ends (-35.2 +/- 46.2 bp) compared with that in he-LAK (16.8 +/- 41.5 bp) (p = 0.0448). The telomerase activity was initially detectable on day 2 in all he-LAK, whereas 8 (61.5%) of 13 ca-LAK expressed telomerase activity on day 3 or later following the stimulation, showing a significant retardation of telomerase expression (p = 0.0116). The addition to the LAK cell generation system of serum from cancer patients, as well as IL-10, but not transforming growth factor (TGF)-beta, suppressed the telomerase activity. This serum-induced suppression of telomerase activity in LAK cells was abrogated with the addition of anti-IL-10 antibody but not with anti-TGF-beta antibody. It is suggested that the dysregulation of telomerase activity and expression exists in LAK cells of cancer patients, resulting in the impairment of LAK cell generation in patients with advanced cancer. Serum IL-10 may be involved in the impairment of LAK cell generation by the suppression of telomerase activity of lymphocytes in vivo. Thus, the dysregulation mechanism of telomerase activity and expression in lymphocytes of cancer patients may be attributable, in part, to cancer-associated immunosuppression.

Aged↗

PubMedDate not supplied

Down-regulation of IL-10 enhances the efficacy of locoregional immunotherapy using OK-432 against malignant effusion.

To determine the significance of interleukin (IL)-10 in antitumor immune response, the effect of the down-regulation of tumor-derived IL-10 on locoregional immunotherapy was investigated. C3H/HeN mice were intraperitoneally (i.p.) inoculated with IL-10-producing murine breast cancer cell line, FM3A, and treated with locoregional administration of OK-432 with or without anti-IL-10 monoclonal antibody (mAb). Anti-IL-10 mAb did not affect the in vitro growth of FM3A cells. Administration of OK-432 plus anti-IL-10 mAb remarkably delayed the retention of malignant ascites and prolonged the survival of mice compared with the administration of OK-432 alone. Spleen cells which were collected from mice treated with OK-432 plus anti-IL-10 mAb and further stimulated in vitro with inactivated FM3A cells exhibited significantly higher cytotoxicity against FM3A cells than those from mice treated with OK-432 alone or from the control mice. The expression of major histocompatibility complex (MHC) class II molecules on spleen cells was up-regulated in vitro by the addition of OK-432 and anti-IL-10 mAb. Using semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), cytokine mRNA levels of peritoneal exudate cells (PEC) and spleen cells were assessed on day 7 (before treatment) and day 14 (after treatment). In PEC, increased expression of IL-2 was observed with the administration of OK-432 plus anti-IL-10 mAb. In spleen cells, the expression of IL-2, IL-12 and IFN-gamma were strongly induced, and IL-4 expression was reduced by the administration of OK-432 plus anti-IL-10 mAb. It is suggested that down-regulation of tumor-derived IL-10 induces the up-regulation of the T helper type (Th) 1 population, resulting in an enhancement of the efficacy of locoregional immunotherapy with OK-432.

Animals↗