Association Between the Fertile Period and Live Birth Post-Kidney Transplantation: A Retrospective Single-Center Cohort Study.

BACKGROUND: Despite restoration of fertility after kidney transplantation, the benefit is limited in female kidney recipients. Our objective is to determine the reasons for this discrepancy. METHODS: We evaluated 315 women who underwent kidney transplantation from 1983 to 2015 (a median of age at transplantation [10th-90th percentile] of 32 years [7-55 years]); 230 recipients between the ages of 15 to 49 years old as of March 2016 were observed. RESULTS: We experienced 10 abortions and 21 live births from our 23 recipients and 2 abortions and 7 live births in 7 recipients from other transplant center. The live birth rate was 8.9 per 1000 female transplant recipients of childbearing age. Seven recipients received either treatments of artificial insemination or in vitro fertilization. Average age at pregnancy was 33.2 ± 3.2 years old, and the fertile period post-transplantation was longer in recipients with live births than those without live births (14.1 ± 7.1 vs 9.9 ± 7.3 years, P < .05). In 42.9% of recipients with live birth, pregnancy-induced hypertension was observed in the last trimester. The gestational age and the average birth weight were 32.8 ± 5.0 months and 2184 ± 632 g, respectively. During follow-up of 14.5 years, there was one case of graft loss, which is a rate of 2.5 per 1000 female recipients. CONCLUSION: Although pregnancy complications are often observed in kidney recipients, graft survival is less influenced by pregnancy. Importantly, kidney disease at childbearing age disrupts pregnancy even after kidney transplantation.

Assessment of tissue-engineered stomach derived from isolated epithelium organoid units.

OBJECTIVE: Isolated stomach epithelial organoid units developed on biodegradable polymers were transplanted to assess the feasibility of a tissue-engineered stomach. BACKGROUND: Despite recent advances in reconstruction techniques, total gastrectomy is still accompanied by various complications. An alternative treatment would be a tissue-engineered stomach, which replaces the mechanical and metabolic functions of a normal stomach. METHODS: Stomach epithelial organoid units isolated from neonatal rats were seeded onto biodegradable polymers. The constructs implanted into the omenta of adult rats were harvested for examination at designated times. Nine rats underwent a second operation for anastomosis. RESULTS: The constructs resulted in cyst-like formations showing vascularized tissue with neomucosa lining the lumen. The surface morphology as assessed using scanning electron microscopy was similar to that of a native stomach. Immunohistochemical staining for alpha-actin smooth muscle and gastric mucin indicated the presence of a smooth muscle layer and a well-developed gastric epithelium, respectively. The luminal surface of the anastomosed tissue-engineered stomach was well-covered with epithelium. CONCLUSIONS: Epithelium-derived stomach organoid units seeded on biodegradable polymers and transplanted into donor rats were shown to vascularize, survive, and regenerate into complex tissue resembling native stomach. Anastomosis between the units and native small intestine may have the potential to stimulate epithelial growth. This research may provide insight into new approaches to alleviate complications following total gastrectomy.

Effects of 5-fluorouracil derivative UFT on thymidylate synthetase and thymidine kinase in rat colorectal tumors.

BACKGROUND: Thymidylate synthetase and thymidine kinase are key enzymes involved in de novo and salvage pathways for pyrimidine nucleotide synthesis, respectively. MATERIALS AND METHODS: Weekly injections of 1,2-dimethyl-hydrazine induced high incidence of colorectal adenocarcinomas in rats. RESULTS: An increased activity of thymidylate synthetase was found in the poorly differentiated adenocarcinomas of the chemically induced rat colorectal tumors. Six-week oral administration of 1-(2-tetrahydrofuryl)-5-fluorouracil in combination with uracil (UFT) reduced the total number of colorectal tumors, with the reduction of thymidylate synthetase activity in the poorly-differentiated type, though the mRNA expression of thymidylate synthetase and thymidine kinase differed little between the groups with or without UFT treatment. CONCLUSIONS: These results indicate that the long-term oral administration using UFT suppresses colorectal carcinogenesis and the growth of the poorly-differentiated type tumors.

Laparoscopic drainage of an intramural duodenal hematoma.

A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football. A diagnosis of intramural hematoma of the duodenum was made using computed tomography and upper gastrointestinal tract contrast radiography. The hematoma caused obstructive jaundice by compressing the common bile duct. The contents of the hematoma were laparoscopically drained. A small perforation was then found in the duodenal wall. The patient underwent laparotomy and repair of the injury. Laparoscopic surgery can be used as definitive therapy in this type of abdominal trauma.

Various problems during long-term percutaneous cardiopulmonary support.

A 54-year-old man with a left ventricular free wall rupture following acute anterior myocardial infarction underwent a repair surgery with percutaneous cardiopulmonary support (PCPS). During surgery and postoperatively, PCPS provided sufficient support flow. The patient was successfully weaned from PCPS on the 15th postoperative day and discharged subsequently. In the management of cardiac rupture patients, PCPS has the merit of preventing rupture progression and the advantage of recovery of pulmonary function. However, there are several problems to solve. The support effectiveness and recovery of the patient's heart should be carefully evaluated. Effective left heart decompression also needs to be established. Heparin-coated circuits still need proper anticoagulation treatment to prevent thrombus formation especially while support flow is low. A circuit construction that allows easier maintenance and safer exchange of oxygenators and pump heads is suggested. Ischemia of the cannulated leg should be prevented by femoral artery perfusion.

[Removal of infected pacemaker leads in the elderly under extracorporeal circulation: two case reports and review of Japanese literature].

Two elder cases in whom infected pacemaker leads were removed under extracorporeal circulation (ECC) are reported. The leads could not be with drawn without direct sharp dissection under ECC because they had become firmly encased with fibrous tissue within the right ventricle. Postoperative courses were uneventful and neither of these patients has experienced recurrent infection to date. Removal with ECC seems to be a safe and effective procedure even in the elderly, provided that cardiac function is good.

[A case of mitral valve replacement with chronic idiopathic thrombocytopenic purpura after high-dose immunoglobulin infusion].

A 60-year-old female patient diagnosed as having mitral stenosis with chronic idiopathic thrombocytopenic purpura (ITP), with a platelet count of 6.8 x 10(4)/mm3, was scheduled to undergo mitral valve replacement. High-dose immunoglobulin infusion (400 mg/kg/day for five days) was begun four days before the operation and increased the platelet count to 9.1 x 10(4)/mm3 just before the operation. Intraoperative hemostasis was excellent, and the postoperative course was uneventful. High-dose immunoglobulin therapy appears to be a first choice for controlling hemorrhagic tendency in ITP patients undergoing heart surgery.

[A case of surgical treatment of sever constrictive pericarditis with biventricular failure].

A 68-year-old woman had been pointed out a calcification of pericardium on chest X-ray ten years ago. She admitted to our hospital associated with generalized edema. RA pressure.pulmonary capillary wedge pressure.RVEDP.LVEDP increased markedly and low cardiac output coexisted (C.I. = 1.77 l/min/m2). On September 9, 1992, she underwent a total pericardiectomy through mediansternotomy without cardiopulmonary bypass. She complicated a prolonged biventricular heart failure despite total pericardiectomy postoperatively. It was considered that delayed clinical improvement had based on myocardial degeneration or atrophy in long-term morbidity. We recommend a early operative intervention at the clinical hemodynamic deterioration.

[Gastric juice secretion increases during extracorporeal circulation employed in cardiac surgery].

We evaluated gastric juice secretion during extracorporeal circulation (ECC) in cardiac surgery. The effect of pirenzepine, a muscarine receptor blocker, was also tested to clarify the mechanism involved. Gastric juice secretion increased significantly from pre ECC value of 3.8 +/- 1.3 ml.h-1 to 12.4 +/- 4.0 ml.h-1 during ECC. It decreased to 5.0 +/- 1.4 ml.h-1 (mean +/- SE) after ECC. Pirenzepine premedication reduced serum gastrin level. However, it did not suppress the increase of gastric juice secretion. There is no significant correlation between serum gastrin level and gastric juice secretion. ECC is a major stress and increases gastric juice secretion. This phenomenon is probably activated via sympathetic and hypophysis-adrenal gland system.

A Case of Stromal Sarcoma of the Breast Coexisting with Noninvasive Ductal Carcinoma.

This paper describes a very rare case of stromal sarcoma of the breast coexisting with simultaneous noninvasive ductal carcinoma in the same breast. A 75-year-old female was seen at our hospital for a lump in the right breast. On physical examination, a 10 x 8 cm well-difined and movable hard mass with a smooth surface was palpated in the upper outer quadrant of the breast. Aspiration cytology suggested a non-epithelial tumor with marked dysplasia (class 3b). Drill biopsy revealed probable stromal sarcoma. Simple mastectomy and axillary lymphonode sampling was performed. Histologically, the tumor was stromal sarcoma in the upper outer quadrant of the breast. In addition, noninvasive ductal carcinoma was simultaneously detected in the upper inner quadrant of the breast as an independent lesion. No positive axillary nodes were found. To date, as far as we could investigate, there was no preceding case report of both stromal sarcoma and carcinoma in the single patient at the same time.

[A case report of tricuspid replacement for the acquired tricuspid stenosis at the time of reoperation].

A 57-year-old woman, who underwent aortic valve replacement and open mitral commissurotomy nine years ago, was admitted with congestive heart failure due to mitral regurgitation and tricuspid regurgitation, for which we planned mitral valve replacement and tricuspid annuloplasty. Intraoperatively, the orifice of tricuspid valve was stenosed like fish-mouth, which we attempted to make commissurotomy and modified Kay's annuloplasty, but failed to decrease the central regurgitation. A CarboMedics 23 mm prosthesis was implanted in the mitral position and a Capentier-Edwards 29 mm in the tricuspid position. She had recovered from congestive heart failure postoperatively, no regurgitant flow was detected in right ventriculography.

[Surgical treatment for a coarctation of the aorta in an advanced aged woman].

A 55 year old woman with coarctation of the aorta underwent coarctectomy by end to end anastomosis successfully. She had no showed sign and symptom except hypertension until 55 years of age. Preoperative findings of cardiac catheterization and aortography were as follows: a pressure gradient of 100mmHg at the severe, short segmental coarctation and prominent development of internal mammary artery and intercostal artery as collateral circulation. After coarctectomy, hypertension improved and postoperative examination revealed no pressure gradient. This is a surgically resected case of coarctation of the aorta in the most advanced aged woman in Japanese literature.

[A case report of giant mediastinal thyroid carcinoma with SVC syndrome].

A 78-year-old man with SVC syndrome caused from compression by follicular carcinoma of the thyroid which extended to the mediastinum was presented. CT and MRI demonstrated a giant right thyroid tumor which extended to the mediastinum and displaced the trachea. The resection of 675 g-tumor was performed through median sternotomy and right collar incision without reconstruction of SVC. His postoperative course was complicated with recurrent nerve paralysis which had been gradually improved for several months. At present, he has been freed from SVC syndrome.

[Blunt trauma with combined femoral arterial and venous occlusion].

Blunt trauma to common femoral artery is rare, and it is frequently unrecognized. A 61-year-old man who fell while carrying a log and struck on his right groin, presented right leg edema and intermittent claudication one month later. Both right femoral arterial and venous occlusion was suspected by Doppler flowmeter, confirmed by venography and arteriography which showed concomitant external iliac arterial occlusion. He underwent prosthetic bypass grafting from common iliac artery to common femoral artery and embolectomy of femoral vein. Circulation to the right leg was restored, but postphlebitic syndrome had remained which was ameliorated by wearing the elastic stocking.

[A successful mitral valve replacement for infective endocarditis with mitral valve aneurysm].

We reported a rare case of mitral valve aneurysm. The patient was a 67-year-old woman with regurgitation of mitral and aortic valve due to infective endocarditis. Preoperative two-dimensional echocardiogram revealed a aneurysmal change and prolapsing on anterior mitral leaflet. Left ventriculogram showed mitral regurgitation of Sellers IV. She underwent mitral valve replacement with 27 mm Carbo Medicus prosthesis successfully. There was a perforated valvular aneurysm (21 x 15 x 11 mm) and inflammatory cleft on anterior mitral leaflet at histopathological findings. The pathogenesis of mitral valve aneurysm was generally infective endocarditis and rarely congenital anomaly, syphylis, Aortitis syndrome, or Marfan syndrome. Mitral valve replacement was a procedure of choice for mitral valve aneurysm, which is especially large, perforated and severely inflammatory one.

[Successful surgical repair for a patient with atrial septal defect and severe pulmonary hypertension--its surgical indication and prostaglandin E1 use for postoperative pulmonary hypertensive crisis].

A 45-year-old woman with atrial septal defect and pulmonary hypertension was admitted for surgical repair. Cardiac catheterization data revealed pulmonary to systemic flow ratio (Qp/Qs) of 1.81, pulmonary artery pressure (PAP) of 82/30 mmHg and pulmonary vascular resistance (PVR) of 10.8 unit. Open lung biopsy was added to evaluate pulmonary vascular obstructive disease (PVOD) which was shown Heath-Edwards grade 3 PVOD. Following closure of the defect, PAP (systolic) exceeded momentarily systemic level after cardiopulmonary bypass. Prostaglandin E1 drip was remarkably effective to bring down PAP during early postoperative period. Although PAP has not been shown significant decrease on catheterization of one year after surgery, great symptomatic improvement has been achieved.

[A case report of central pontine myelinolysis associated with serum hyperosmolality after open heart surgery].

A 65-year-old man was admitted with a sudden onset of dyspnea. Severe mitral regurgitation due to torn chordae tendinae was revealed on UCG. Mitral valve replacement was undergone. The postoperative course was complicated with a low cardiac output syndrome which was successfully treated with IABP, catecholamines and vasodilators. However, stupor developed on the 4 th postoperative day, following by tetrapregia on the 8 th day, and deep coma on the 15 th day respectively. Laboratory studies of the 4 th day disclosed the following values, serum sodium 150 mEq/l, blood urea nitrogen 84.7 mg/dl, blood sugar 184 mg/dl and calculated serum osmolality 354 mOsm/l. Cranial CT of the 15 th day showed an obscure low density area in the central pons which was strongly suggestive of central pontine myelinolysis (CPM). His CNS symptoms improved dramatically after administration of thyrotropin-releasing hormone tartrate (TRH-T). A diagnosis of CPM was made on MRI of the 41 st day. He discharged without any neurological deficit on the 62 nd day.

[A case of surgically treated tuberculous aneurysm of descending thoracic aorta with massive hemoptysis].

A tuberculous aneurysm of the thoracic descending aorta was found in a 60-year-old female with massive hemoptysis. She had had lung tuberculosis one and half years ago. Computed tomography and aortic angiography revealed saccular type aneurysm at left supradiaphragmatic portion of descending aorta. After antituberculous chemotherapy, the aneurysm was resected under the temporary bypass support utilizing Bio-pump and the aorta was grafted with Dacron prosthesis successfully. The microscopic findings of specimens over the aneurysm and surrounding tissues revealed tuberculosis. The patient is doing well one year after the operation.

[Adrenomedullary epinephrine excretion and myocardial norepinephrine release during cardiopulmonary bypass].

It has long been known that shock or surgical stress promotes an epinephrine (E) excretion from the adrenomedullary glands. In fourteen adult cardiac patients, plasma E values in both superior vena cava (SVC) cannula and inferior vena cava (IVC) cannula during total cardiopulmonary bypass (CPB) are studied at three stages, before aortic cross clamp (pre AXC), after release of aortic cross clamp (post AXC) and at 34 degrees C rectal temperature in rewarming (34 degrees C RT). Although E values in both SVC and IVC are slightly higher values than normal in pre AXC, they increase sharply to peaked values at post AXC and decline uniformly close to normal at 34 degrees C RT. IVC-E is constantly significantly higher (statistically) than SVC-E at each of all three stages. It is strongly suggested that E response to CPB is mainly originated from the adrenomedullary glands, and cardiac reflex which has sympathetic efferent limbs triggered by myocardial ischemia can indicate the increase in E during AXC. Myocardial norepinephrine (NE) release in heart ischemia such as acute myocardial infarction has been generally accepted. To examine whether myocardial NE release occurs during AXC, if there is the association of NE release with any clinical parameters, the second investigation is done in twenty-six adult cardiac patients. Plasma NE values in both the radial artery (A) and the coronary sinus (CS) are measured at six stages, pre AXC (stage 1), post AXC (stage 2), post CPB (stage 3), three hours after off CPB (stage 4), six hours off CPB (stage 5) and twelve hours off CPB (stage 6).(ABSTRACT TRUNCATED AT 250 WORDS)