Laparoscopic cornuotomy for interstitial pregnancy and postoperative course.

AIM: The aim of this study was to evaluate the advantages of laparoscopic cornuotomy in treating interstitial pregnancy, and the effect of the procedure on reproductive outcomes. METHODS: Thirteen patients were treated for interstitial pregnancy by laparoscopic cornuotomy with or without local methotrexate injection, between March 2000 and January 2012 at NTT East Japan Tohoku Hospital and Sendai City Hospital. The patients were followed to assess the outcomes of subsequent pregnancies for at least 1 year after the operation. RESULTS: All 13 cases of interstitial pregnancy were successfully treated by laparoscopic cornuotomy, without performing cornual resection or laparotomy. The mean gestational age was 7.6 ± 1.3 weeks, and the average serum hCG level was 20,800 ± 18,100 IU/L. The mean cornual mass size was 34.6 ± 10.2 mm. Eight of the patients later obtained a spontaneous intrauterine pregnancy. Three patients that delivered by cesarean section showed no uterine dehiscence or thinning of the scar at the site of the earlier cornual incision and repair. None of the patients experienced uterine rupture. CONCLUSION: Interstitial pregnancy can be selectively treated by laparoscopic cornuotomy with local methotrexate injection, if managed carefully.

[A case where the tracheotomy tube was burned during Nd-YAG laser cautery treatment for tracheal neoplasm].

For the treatment of the residual tumor above the incision site, laser cautery was scheduled. Artificial ventilation was carried out using a tracheotomy tube, and a laser fiber was inserted orally for tumor ablation. During the procedure, white smoke appeared in the oral cavity. Considering the damage to the tube, laser use was discontinued and the tube was replaced with a new one. The removed tube had burn marks, but penetration of the tube wall was not observed. Neither respiratory tract burn was found. Prior consultation with technicians regarding the use and settings of the laser appatrates is required.

Development of full-thickness human skin equivalents with blood and lymph-like capillary networks by cell coating technology.

We developed a human skin equivalent (HSE) containing blood and lymph-like capillary networks using a cell coating technique, which is a rapid fabrication technology of three-dimensional cellular constructs by cell surface coating using layer-by-layer assembled nanofilms of extracellular matrices. The thickness of dermis consisting of normal human dermal fibroblasts was easily controlled from approximately 5 to 100 µm by altering the seeded cell number. Keratinocytes as a major cell population showed homogeneous differentiation on the surface of the dermis by lifting to air-liquid interface. Histological analysis revealed four distinct layers such as basal layer, spinous layer, granular layer, and cornified cell layer in the epidermis. Interestingly, the measurement of transepithelial electrical resistance (TEER) indicated prolongation of the attainment time for maximum value by increasing the number of the dermal fibroblasts, and the HSEs with six layers of dermis revealed the longest period maintaining over 500 Ω cm(2) of TEER. The co-sandwich culture of human umbilical vein endothelial cells and normal human dermal lymphatic microvascular endothelial cells within eight-layered dermis showed in vitro co-network formation of individual blood and lymph-like capillaries inside the dermis. This is the report for homogeneous full-thickness HSEs with blood and lymph capillary networks, which will be useful for biomedical and pharmaceutical applications.

Effect of combined treatment of oral sorbent with protein-restricted diet on change of reciprocal creatinine slope in patients with CRF.

BACKGROUND: Low-protein diet (LPD) is one therapy and AST-120, an oral carbon adsorbent, is the other therapy to reduce blood levels of indoxyl sulfate in patients with chronic renal failure (CRF). Based on the different mechanisms of reducing indoxyl sulfate levels, the addition of AST-120 to an LPD was investigated. METHODS: Seven hundred twenty-two patients with chronic glomerulonephritis (CGN) and 162 patients with diabetic nephropathy (DN) were stratified by protein intake: less than 0.50 g/kg/d (0.50-g/kg/d group), 0.51 to 0.65 g/kg/d (0.65-g/kg/d group), and 0.66 to 0.80 g/kg/d (0.80-g/kg/d group). To analyze the effect of combined AST-120 therapy (6 g/d) in patients on LPD therapy, the slope of the reciprocal of serum creatinine (1/Cr slope), which represents progression of CRF, was applied. RESULTS: (1) In patients with CGN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.50-g/kg/d (n = 152), 0.65-g/kg/d (n = 318), and 0.80-g/kg/d (n = 252) groups changed significantly from -430 x 10(-5) to -83 x 10(-5), -333 x 10(-5) to -102 x 10(-5), and -431 x 10(-5) to -116 x 10(-5) dL/mg/wk. (2) In patients with DN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.65-g/kg/d (n = 74) and 0.80-g/kg/d (n = 68) groups changed significantly from -602 x 10(-5) to -125 x 10(-5) and -646 x 10(-5) to -185 x 10(-5) dL/mg/wk. CONCLUSION: It is suggested that the addition of AST-120 to a mild LPD provides the comparable effect with a strict LPD in the point of suppressing the progress of CRF.

Comparison of two dosages of thymoglobulin used as a short-course for induction in kidney transplantation.

Thymoglobulin is used effectively as an induction agent in kidney transplantation, but the optimal dose is not well established. We evaluated the degree and durability of T-cell clearances with two different thymoglobulin regimens in adult kidney transplant recipients (KTR). Seven KTR received a 3-day thymoglobulin-based induction of 1.0 mg/kg/day while nine received 1.5 mg/kg/day, in addition to maintenance immunosuppression. Lymphocyte subsets were monitored for 6 months. Renal function, infections and malignancies were monitored for 24 months. T-cell subsets were significantly lower by day 30 with the thymoglobulin 1.5 mg/kg/day regimen when compared with the 1.0 mg/kg/day regimen; this trend was sustained at 6-month (CD3(+): 438 +/- 254 vs. 1001 +/- 532 cells/mm(3), P = 0.016). Renal function between the two groups was not significantly different at 6- and 24-months post-transplant. One case of BK Virus viremia in the 1.5 mg/kg/day thymoglobulin group was detected. No acute rejection episodes, cytomegalovirus infections, or malignancies were noted in either group. Thymoglobulin induction was efficacious in both groups, but with a significantly sustained T-cell clearance in the 1.5 mg/kg/day regimen. A more profound T-cell clearance within the first 6 months postinduction therapy may translate into a decreased risk of immunological injury and improved long-term outcome after kidney transplantation.