Intra-vitreal gas injection and supine positioning for hypotony post-intrascleral intraocular lens fixation.

PURPOSE: This study aimed to report a case of intravitreal gas injection in the supine position for hypotony after intrascleral intraocular lens (IOL) fixation in a patient with Vogt-Koyanagi-Harada (VKH) disease. OBSERVATIONS: A 72-year-old Japanese female patient presented with blurred vision in her right eye. Both eyes exhibited a sunset glow fundus due to VKH disease. The right IOL was dislocated; therefore, IOL fixation was performed. The patient's hypotony and choroidal effusion persisted postoperatively and her intraocular pressure (IOP) remained 2-4 mmHg despite the performance of two steroid courses. C3F8 (perfluoro pane gas) was injected into the vitreous cavity on postoperative day 35. The patient was instructed to assume a supine position on the third day after injection. At 6 days post-injection, her IOP began to rise; her IOP remained within the normal range until 1 year later. CONCLUSIONS AND IMPORTANCE: This is the first report of successful intravitreal gas injection in a supinated patient with VKH disease to treat postoperative hypotony.

Comparison of Surgical Outcomes Between Ab Interno Suture Trabeculotomy and Ab Externo Metal Trabeculotomy in Adult Patients with Glaucoma.

PURPOSE: To compare the outcomes of ab interno suture trabeculotomy (AbI-TLO) and ab externo metal trabeculotomy (AbE-TLO) in adult patients with glaucoma aged over 40 years. PATIENTS AND METHODS: A retrospective chart review was conducted, including adult patients with glaucoma who underwent AbI-TLO or AbE-TLO between January 2015 and June 2019. A single surgeon (YO) performed all the operations. Eighty-one patients (81 eyes) were included in this study. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤18 mmHg and an IOP reduction of ≥20% from the preoperative IOP, without requiring additional glaucoma surgery. Success rates were assessed using Kaplan-Meier survival curves and log-rank (Mantel-Cox) tests, while risk factors were analyzed using the Cox proportional hazards model. RESULTS: Forty-nine patients who underwent AbI-TLO and 32 patients who underwent AbE-TLO were studied; the preoperative IOPs were 27.9 ± 7.3 (mean ± standard deviation) mmHg and 25.6 ± 8.1 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.217). The 12-month postoperative IOPs were 15.8 ± 4.0 mmHg and 16.3 ± 4.2 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.724). The surgical success rates at 12 months were 77.6% and 62.5% in the AbI-TLO and AbE-TLO groups, respectively (p=0.144). Postoperative hyphema with level formation and ocular hypertension over 30 mmHg were observed in 22.4% and 26.5% of patients in the AbI-TLO group and 18.8% and 12.5% of those in the AbE-TLO group, respectively. Stepwise multivariate Cox regression analysis showed that a longer axial length was a risk factor for surgical failure (hazard ratio: 2.030; p=0.042). CONCLUSION: AbI-TLO and AbE-TLO had similar surgical outcomes and postoperative complications. A longer axial length was associated with an insufficient IOP reduction.

Subarachnoid hemorrhage-negative Terson syndrome after intracranial artery treatment with a flow diverter device.

PURPOSE: To report a case of subarachnoid hemorrhage-negative Terson syndrome following intracranial artery treatment with flow diverter stents. OBSERVATIONS: A 40-year-old Asian woman presented with floaters in her right eye after treatment of an intracranial aneurysm with flow diverter stents. Vitreous hemorrhage and sub-inner limiting membrane (sub-ILM) hemorrhage were present in her right eye. On fluorescein angiography, contrast perfusion and vascular occlusion were not noted. Magnetic resonance imaging (MRI) did not show any evidence of subarachnoid hemorrhage (SAH). We hypothesize that the bleeding was due to Terson syndrome associated with intracranial treatment with the flow diverter stents. During follow-up, the vitreous hemorrhage and sub-ILM hemorrhage disappeared, and the floaters in her vision improved. CONCLUSIONS AND IMPORTANCE: This is the first reported case of vitreous hemorrhage and sub-ILM hemorrhage that should be considered to be Terson syndrome, after flow diverter stents treatment in the absence of SAH.

Synthesis, Structures, and Properties of Neutral and Radical Cationic S,C,C-Bridged Triphenylamines.

A structurally constrained S,C,C-bridged triphenylamine was synthesized, and the corresponding radical cation was obtained as a hexachloroantimonate by chemical oxidation. An X-ray crystallographic analysis revealed an almost planar structure for this radical cation, which thus represents the first example of a planar, para-unsubstituted triphenylamine radical cation analogue with a sulfur bridge. The electronic properties of the radical cation were examined by UV-vis-NIR and ESR spectroscopy as well as DFT calculations.

Perturbation effect of parallel-plate ionization chambers on buildup dose measurements in transverse magnetic fields.

The aim of this study is to investigate the perturbation effect of parallel-plate ionization chambers on the buildup dose measurement in transverse magnetic fields, using Monte Carlo (MC) simulation. The NACP-02 and ROOS parallel-plate chambers and a PTW31010 cylindrical chamber were modeled for buildup dose measurement in magnetic fields, using the EGSnrc/cavity code. The irradiation condition was set to a 10 × 10 cm2 field in a water phantom at a source-to-surface distance (SSD) of 100 cm, using 6-MV photon spectrum. Magnetic fields of 0 0.35, 1.0, 1.5, and 3.0 T were applied perpendicularly to the direction of the photon beam. The overall perturbation factor PQ,B for the ionization chambers in the magnetic fields was also calculated. The dose to water was enhanced with increasing the magnetic field strength at a depth of less than 1 cm. Over a depth of 1.5 cm, there was no significant difference in the depth doses with and without magnetic field in water. The maximum depth dose (%) for the NACP-02 and ROOS chambers at 1.5 T was higher up to 12% and 14% than the maximum depth dose at 0 T, respectively. The depth dose curves of a PTW31010 chamber have a similar tendency to those of water. The PQ,B values for each chamber were the largest at the phantom surface. The transverse magnetic field has a greater effect on the dose response of the NACP and ROOS chambers than that of the PTW31010 chamber in the buildup region.

Dependence of volume dose indices on dose calculation algorithms for VMAT-SBRT plans for peripheral lung tumor.

The purpose of this study was to investigate the dependence of volume dose indices on dose calculation algorithms for volumetric modulated arc therapy (VMAT) for stereotactic body radiotherapy (SBRT) plans to treat peripheral lung tumors by comparing them with those of Monte Carlo (MC) calculations. VMAT-SBRT plans for peripheral lung tumors were created using the Eclipse treatment planning system (TPS) for 24 patients with nonsmall cell lung cancer. VMAT dose distributions for gross tumor volume (GTV), internal target volume (ITV), and planning target volume (PTV) were calculated using the analytical anisotropic algorithm (AAA), the Acuros XB (AXB) algorithm, and a MC algorithm. VMAT dose distributions of the 3 algorithms were compared using their volume dose indices from dose volume histograms (DVHs), a dose difference map, and 3-dimensional gamma analysis. The DVHs for GTV and ITV from AAA, AXB, and MC were in good agreement. The difference between the ITV and PTV volume dose indices from AAA and MC increased as D98, D95, D80, D50, and D2. In particular, the difference between D98 for PTV from AAA and MC was up to 48%. A >5% difference between D95 for PTV from AAA and MC was 11 patients, but only 2 patients for ITV. The volume dose indices for AXB were near those of MC. AAA tended to overestimate the PTV volume dose indices compared to AXB and MC. Thus, we propose that the volume dose indices for the ITV be used because they are independent of dose calculation algorithms.

Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report.

BACKGROUND: Chronic retinal necrosis (CRN) is a rare chronic granular necrotizing retinitis that was first described in 2013. CRN is characterized by intraocular inflammation accompanied by occlusive vasculitis, granular retinitis, and slowly progressing necrosis around the retina in a host with partial immune dysfunction. Cytomegalovirus (CMV) is reported to be a causative agent. There are several ocular complications such as retinal detachment and neovascular glaucoma; however, there has been no description of a clinical manifestation of neovascular glaucoma in CRN. We herein present a case of severe neovascular glaucoma in association with CRN. CASE PRESENTATION: An 80-year-old man was referred to our hospital with poor control of inflammation and intraocular pressure (IOP). The IOP in his left eye was 29 mm Hg. Anterior chamber cells (2+) and keratic precipitates were observed. In the peripheral retina, vitreous opacities and granular necrotizing retinitis were noticed. Fluorescein angiography revealed extensive retinal nonperfusion area from the macula lesion to the periphery. PCR analysis of aqueous humor showed the presence of CMV. A diagnosis of CRN was made soon afterwards. Antiviral drug and systemic corticosteroid were administered. The treatment temporally resolved the symptom; however, panretinal photocoagulation and intravitreal injection of bevacizumab were performed to treat iris neovascularization. During the follow-up, trabeculectomy was performed because of poor IOP control. At the final visit, severe uncontrolled neovascular glaucoma caused hyphema, and his left eye lost light perception. CONCLUSION: The prognosis of CRN is poor because of severe neovascular glaucoma and careful observation and active treatments are necessary.

Krüppel-like factors 4 and 5 expression and their involvement in differentiation of oral carcinomas.

Proliferation-differentiation balance of epithelial cells is regulated by Krüppel-like factors (KLF) 4 and 5, and the unbalanced expression relates to carcinoma progression. However, little is known about the expression and role in oral carcinomas. This study examined expression of KLF4 and KLF 5 in the carcinomas by immunohistochemistry (n = 67) and the involvement in proliferation and differentiation of carcinoma cells. KLF4 was detected in keratinizing carcinoma cells and KLF5 in non-keratinizing cells. KLF4 staining declined in the patient with lymph node metastasis (P < 0.05) and in parallel with the histological dedifferentiation (P = 0.09). Exogenous overexpression of KLF4 arranged cells in a cobble-like structure with desmosomes and KLF5 elongated cells like fibroblasts without desmosomes. KLF4 suppressed fibronectin expression, and KLF5 down-regulated and degraded E-cadherin. The proliferation was not affected by KLFs. Thus, down-regulation of KLF4 and up-regulation of KLF5 may stimulate oral carcinoma progression through the dedifferentiation of carcinoma cells.

Ortho-phthalaldehyde-induced skin mucous membrane damage from inadequate washing.

Because body fluids and blood have a tendency to adhere to transesophageal echo devices, a high level of sterilisation is required when cleaning them. Ortho-phthalaldehyde (OPA) has been widely used in Japan since being approved as a high-level sterilant. The authors report a patient with widespread, severe skin and mucous membrane damage of the lip, tongue, pharynx and oesophagus areas that was attributed to inadequate washing after the sterilisation of a transesophageal echo device with OPA. This patient experienced sequelae, which did not improve after more than 1 year of continuous treatment. When using medical devices sterilised with OPA, the use of a probe cover, when applicable, is recommended and complete washing prior to use is required.

Recurrent pancreatitis caused by pancreatobiliary anomalies in children with annular pancreas.

PURPOSE: Annular pancreas (AP) is usually associated with duodenal obstruction in neonates. Pancreatitis with AP occurs frequently in adults but is rare in children. This article describes pancreatitis in children with AP and pancreatobiliary anomalies and its surgical treatment. PATIENTS AND METHODS: Six children who underwent duodenal bypass for AP subsequently developed recurrent pancreatitis. Three had trisomy 21. Duodenoduodenostomy had been performed in 5 patients and gastrojejunostomy in 1 patient for neonatal duodenal obstruction. We reviewed overall management, imaging, and surgical treatment in these children. RESULTS: All children subsequently complained of recurrent abdominal pain. Pancreatitis developed in 6 children, and magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed associated pancreatobiliary anomalies such as pancreas divisum, pancreatobiliary malunion, choledochocele, and intraluminal duodenal diverticulum. In 5 cases, surgery for recurrent or chronic pancreatitis was performed. The range of follow-up was 11 to 54 months, and all children who underwent surgery had excellent results. CONCLUSIONS: Children with AP occasionally require reoperation for recurrent pancreatitis because of associate pancreatobiliary anomalies. Magnetic resonance cholangiopancreatography and ERCP provide excellent images of pancreatobiliary anomalies. Intraoperative cholangiopancreatography is also essential for accurate depiction of the ductal structure and selection of the appropriate surgical procedure.

Age-dependent spike localization in various epileptic syndromes.

The electroencephalograms from 276 patients with localization-related epilepsy were analyzed to compare the distribution of spike foci in different age groups. Patients were divided into five groups according to spike location in the frontal, central, temporal, occipital, or multiple cortical regions. The age of peak incidence was earliest in patients with occipital foci, followed by those with central foci and then those with frontal foci. A bimodal age distribution of patients with temporal foci was observed. Symptomatic patients frequently exhibited multiple and frontal foci, and a large number of idiopathic patients had central, temporal, and occipital foci. Multiple foci were detected in 27.5% of idiopathic patients. Age-related spike localization was uniformly observed, regardless of the epileptic syndrome. The analysis of these data indicates that there are two types of multiple foci, one correlated with organic lesions and the other with an idiopathic, functional nature.

Hormone-induced granular convoluted tubule-like cells in mouse parotid gland.

Most striated duct (SD) cells in the adult mouse parotid gland (PAG) have a few small secretory granules. These granules, however, are usually too small and sparse to be detected using light microscopy. Our serial studies have suggested that these PAG SD cells belong to a group of hormone-responsive granular duct cells, similar to the granular convoluted tubule (GCT) cells found in the submandibular gland. These studies also indicate that and some PAG SD cells may be capable of developing a granular cell phenotype under supraphysiological conditions of androgenic and thyroid hormones, leading to more abundant, and more kinds of GCT-specific secretory polypeptides. Here, the cytology of hormone-modulated SD cells, the immunocytochemistry of their secretory products, and their secretory responses to some autonomic agents are reviewed. Finally, the close similarity of the duct systems of the three major salivary glands in mice is critically emphasized.

Histological analysis of the sublingual gland in rats with streptozotocin-induced diabetes.

This study was designed to examine whether the sublingual gland parenchyma is influenced by the development of insulin-dependent diabetes mellitus. The sublingual glands of rats with streptozotocin-induced diabetes were examined by light and electron microscopy. In order to define the limiting membrane of mucous granules in more detail, samples processed by rapid freezing following by freeze-substitution in addition to chemical fixation were also prepared for electron microscopy. Light and electron microscopy showed vacuole-like structures considered to be lipid droplets in the cytoplasm of serous demilune cells, the largest reaching 4 microm in diameter. Electron microscopy of the chemically fixed samples revealed granule-like structures in addition to the mucous granules proper in the mucous cell cytoplasm. However, electron microscopy of the freeze-substitution fixed samples demonstrated no limiting membrane on the surface of the granule-like structures, although this was clearly observed on the surface of the mucous granules. Accordingly, the granule-like structures present in the mucous cell cytoplasm appeared to be lipid droplets. These findings suggest that the sublingual gland mucous cells become dysfunctional during the development of insulin-dependent diabetes mellitus, although to a slighter degree than the serous demilune cells.

Hepaticojejunostomy and intrahepatic cystojejunostomy for type IV-A choledochal cyst.

BACKGROUND: The incidence of choledochal cyst with intrahepatic involvement (Todani's type IV-A cyst) is considerably high. Dilatation of the intrahepatic bile duct is frequently observed around the hepatic hilum, occasionally in the umbilical portion, and rarely in the more upstream intrahepatic bile duct, associated with or without downstream stricture. We recently encountered 2 children with type IV-A cyst associated with upstream intrahepatic ductal dilatation; one with a cystic dilatation of the medial branch arising from the left hepatic duct and another with a cyst of the medial branch arising from the anterior hepatic duct. METHODS: After excision of the extrahepatic bile duct cyst at the hilum and making a large fenestration of the intrahepatic duct cyst, hepaticojejunostomy and intrahepatic cystojejunostomy were performed using a Roux-en-Y jejunal loop in both children. RESULTS: Postoperatively, both intrahepatic cysts were remarkably reduced in size, and recurrent bouts of abdominal pain did not occur for up to 4 or 5 years. CONCLUSION: Hepaticojejunostomy at the hepatic hilum, combined with intrahepatic cystojejunostomy, appears to be a recommendable procedure for an upstream intrahepatic ductal cyst of type IV-A, preventing postoperative cholangitis owing to bile stone formation.

Effects of geldanamycin and thalidomide on the Th1/Th2 cytokine balance in mice subjected to operative trauma.

BACKGROUND: Persistence of postoperative immune dysfunction is a critical problem because it increases the risk of serious infectious complications. The mechanisms of the immune dysfunction that occur initially after non-thermal operative injury remain to be fully elucidated. METHODS: Two mouse models of operative trauma (simple laparotomy to represent minor operative injury and ileocecal resection to represent major operative injury) were used to define the characteristics of initial cytokine synthesis. Geldanamycin and thalidomide were independently added intraperitoneally before and after operative injury to examine the effect on postoperative immune dysfunction. Mice were sacrificed at scheduled times (3, 6, 12, and 24 h after operative injury) and TNF-alpha, IL-2, IL-4, and IL-10 were analyzed. Spleen was used for intracellular cytokines and RT-PCR. Sera were used for ELISA. RESULTS: Major operative injury caused an initial upregulation of IL-10 synthesis with delayed synthesis of TNF-alpha and IL-2. Minor operative injury caused an early induction of IL-2 synthesis preceded by an initial induction of IL-4 synthesis. GA caused a specific early upregulation of TNF-alpha mRNA expression and intracellular TNF-alpha synthesis. The GA and THD groups showed early serum IL-2 production with reduction of IL-10 mRNA expression and intracellular IL-10 synthesis in the early post-operative phase. CONCLUSIONS: Major and minor operative injury showed different Th1/Th2 cytokine patterns in the initial post-operative period. Geldanamycin and thalidomide improved the Th1/Th2 imbalance independently after major operative injury.

[The ideographic iteration mark in Senkinho].

In the 7th century, Senkinho was written by Sonshibaku in the Tang dynasty China. This book that was altered in 1066 in the north Sung dynasty China has become known in the world now. However four series of books remained intact, as they were not modified. The names of each book were Senkinho Kentoushi-syouraibon, the Shincho-sonshinjin senkinho, Stein book, and the Kozlov book. Senkinho Kentoushi-syouraibon and Shincho-sonshinjin Senkinho are in Japan, while Stein and the Kozlov books are in the United Kingdom and Russia respectively. We researched the ideographic iteration marks in these books. In Senkinho Kentoushi-syouraibon, several ideographic iteration marks were used. But in Shincho-sonshinjin senkinho and the Kozlov book, only one ideographic iteration mark was used. Furthermore, there were two types of ideographic iteration marks in the Chinese character text of Senkinho Kentoushi-syouraibon. We estimated that the ideographic iteration marks in the Katakana character were transcribed between the middle era of Kamakura Japan and the early era of Muromachi Japan.

[The association between the medical arts of Japan, Korea, and Ming Dynasty China during Toyotomi Hideyoshi's War].

Traditional Korean medicine's pronounced impact on Japan came about as a result of Toyotomi Hideyoshi's war on Korea in the late 16th century. The influences of Korean medicine on Japan were caused by the introduction not only of a large number of medical books printed in the Yi dynasty and the techniques of publication but also those of the people of talent. We researched one doctor who came to Japan during the war of the Bunroku periods. The name of the doctor was Kintokuho. He learned medicine from a Chinese, Unkai(YunHai). He caused the iatrogenic diseases in the first year and so he changed his medical prescription to fit Japanese. After this, his treatment produced a curative effect. After his death, his art of medicine was passed on to his pupils.

Laparoscopic splenopexy for wandering spleen: extraperitoneal pocket splenopexy.

Wandering spleen is a very rare disease. It is a very dangerous condition due to the risk of splenic ischemia from persistent pedicle torsion. Here, we describe a case of wandering spleen diagnosed by ultrasound and computed tomography scans in an 11-year-old boy who suffered from frequent urination and enuresis. A laparoscopic splenopexy was successfully performed with fixation of the spleen in an extraperitoneal pocket. Since the operation, the organ has remained in place with good perfusion. The details of the procedure are described.

An immunocytochemical study of regeneration of gastric epithelia in rat experimental ulcers.

We experimentally observed the process of regeneration of gastric mucosal cells in ulcers induced by surgical removal of the fundic mucosa of rats. The techniques utilized were immunocytochemistry, laser confocal microscopy, and transmission electron microscopy (TEM). Routine TEM and PAS reaction were used for parietal cells, chief cells, and mucous cells. As markers of parietal cells, H+-K+ ATPase, Na+-K+ ATPase, carbonic anhydrase, and aquaporin 4 (AQP4) were used, and for chief cells pepsinogen was used. Healing process of mucosal defect was as follows. On day 2 after the operation, the single-layered regenerating epithelium (RE) originating from the marginal epithelium of the ulcer extended over the granulation tissue of the ulcer base towards the center. Regenerating glands (RGs) appeared in the ulcer margin. The cells appearing first in the RE were undifferentiated cells that had a high nucleus: cytoplasm ratio and abundant free ribosomes. On day 5, the ulcer was almost filled with RGs. Most cells stained positive for PAS reaction. A few immature parietal cells stained weakly with H+-K+ ATPase, Na+-K+ ATPase, carbonic anhydrase, and aquaporin-4 antibodies, and a few immature chief cells stained weakly with pepsinogen antibody were also observed on day 5. On day 10, the ulcer was filled with RGs. The RGs in the periphery of the ulcer stained positive for markers of mature parietal cells and chief cells, whereas the center of the ulcer was composed of immature parietal cells and chief cells. By day 25, the mucosal defect was filled with normal gastric glands formed by maturation of the RGs. The undifferentiated cells that first appeared in the ulcer margin seem to differentiate to special functioning cells of the stomach 5-10 days after ulcer formation.

Changes in the distribution and fine structure of the intralobular blood vessels of the submandibular gland in the postnatally developing mouse.

Previous studies have shown that the blood vessels supplying the endocrine organs and the mucosa of the intestinal canals change in terms of not only their distribution but also their structure with the development and growth of each organ. We examined changes in the distribution and structure of intralobular blood vessels, including capillaries, throughout the postnatal development of the submandibular gland, an exocrine organ. The mouse submandibular gland from days 0 (birth) to 49 was investigated chronologically and ultrastructurally. The capillaries changed from continuous to fenestrated on day 10, coincident with an increase in the number of acini to more than the number of terminal tubules. The number of sections of intralobular blood vessels per unit area gradually decreased with increasing acinar size and was lowest on day 21 when pups were weaned; the same number was maintained from then on. In contrast with the reduction in the number of intralobular blood vessels, the number of capillary pores appeared to increase gradually. Acinar size increased further till day 28. Capillary pore number also increased further, till day 35, apparently in relation to the increasing acinar size. These findings suggest that the changes in distribution and structure of the intralobular blood vessels in the submandibular gland of the postnatally developing mouse are closely related to the development of the parenchymal cells in preparation for weaning and sexual maturity.