Cementless Total Hip Arthroplasty in Hip Dysplasia with an Extensively Porous-Coated Cylindrical Stem Modified for Asians: A 12-Year Follow-Up Study.

Long-term outcomes of primary cementless total hip arthroplasty were examined for 198 hips of Asian patients with developmental dysplasia of the hip. AML stems were modified for patients' relatively small physique. Stable fixation was achieved despite various proximal femoral deformities. At follow up (mean 12.1 years), radiographs demonstrated fixation in all hips, with 100% stem survivorship. Radiographic changes revealed that the severity of stress-shielding was mild in 55% of hips, moderate in 26%, and severe in 19%. Longer follow up is needed to determine whether these changes will develop into clinical manifestations. A distal fixation stem can be a useful reconstruction option when application of a proximal fixation stem in primary total hip arthroplasty is difficult for various reasons.

[Traumatic hemothorax treated with transcatheter arterial embolization].

A 33-year-old man was transported to our hospital following a traffic accident. He was found to have hemopneumothorax, multiple rib fractures and lung injury by computed tomography(CT). Despite thoracic drainage and fluid resuscitation, he became hemodynamically unstable. At 2 hours after arrival, CT revealed worsening in hemothorax. Emergency angiography of intercostal arteries showed signs of hemorrhage from intercostal arteries, and embolization of the 3∼6th intercostal arteries was performed. After transcatheter arterial embolization(TAE), his vital signs got stable and he was discharged without significant complication.

[A case of bleeding stomal varices during the course of oxaliplatin-based chemotherapy for recurrent rectal cancer].

A 51-year-old man with a history of an abdominoperineal resection of the rectum and colostomy for rectal cancer underwent chemotherapy for multiple liver metastases.Twenty -two courses of the folinic acid, 5-fluorouracil(5-FU)and oxaliplatin(FOLFOX4)/bevacizumab(BEV)regimen and 39 courses of 5-FU/Leucovorin/BEV were administered.Progressive splenomegaly and stomal varices were observed during the course of chemotherapy.The patient was admitted due to excessive bleeding after colostomy.Angiography revealed bleeding stomal varices secondary to portal hypertension.Splenectomy was performed with subsequent reduction in the size of the stomal varices and no rebleeding was observed.Oxaliplatin -based chemotherapy could lead to hepatic sinusoidal dilation and induce splenomegaly and varix formation secondary to portal hypertension.Our experience with this case suggests that careful attention should be paid to stomal varices in colostomy patients receiving oxaliplatin-based chemotherapy.

Primary rhabdoid tumor with low grade glioma component of the central nervous system in a young adult.

In the CNS, primary tumors with rhabdoid components are classified as atypical teratoid/rhabdoid tumor, rhabdoid meningioma or rhabdoid glioblastoma. The authors present a young adult patient with supratentorial rhabdoid tumor incidentally found after head trauma as a small pre-existing lesion in the parahippocampal gyrus. MRI demonstrated an area of hypointensity on T1-weighted images and hyperintensity on T2-weighted and fluid attenuated inversion recovery images. A serial MR scan revealed no change 3 months after the initial examination but drastic changes at 6 months. As the tumor and accompanying intratumoral hemorrhage enlarged rapidly, resection of the tumor was performed. Histopathology revealed that the main component of the tumor was typical rhabdoid cells with some necrotic areas. There were also pathological features consistent with oligoastrocytoma. The specimen had neither vascular proliferation usually seen in high-grade glioma nor the meningothelial pattern that suggests meningioma. Immunohistochemical findings revealed that cells were strongly positive for vimentin, epithelial membrane antigen and INI-1 antibody throughout the specimen. Further, monosomy 22 was detected by fluorescence in situ hybridization. The tumor was finally thought to be an unclassifiable primitive rhabdoid tumor with oligoastrocytoma that arose in the CNS. The patient died within 5 months of detection of the tumor, regardless of surgical resection, radiotherapy and chemotherapy.

Chemotherapy with cisplatin and vincristine for optic pathway/hypothalamic astrocytoma in young children.

OBJECTIVE: Optic pathway/hypothalamic astrocytomas (OPHA) in young children often show accelerated growth and require rather intensive induction chemotherapy. METHODS: Fifteen children (median age: 3 years) with a large OPHA were treated. All of them presented with progressive disease, and the tumor size was larger than 34 mm. Pilocytic astrocytoma was confirmed histologically in 10 patients. Eleven patients had visual disturbance, six had diencephalic syndrome and four had hydrocephalus. RESULTS: The children received six to eight cycles of cisplatin (20 mg/m(2): days 1-5) and vincristine (1.4 mg/m(2): days 1, 8, 15), every 4 weeks. Objective response was obtained in 11 patients (73%); one complete response, eight partial responses and two minor responses. Although the remaining four cases were evaluated as stable disease, all tumors decreased in volume. All children tolerated the chemotherapy well under careful audiological monitoring. CONCLUSION: Although the present series was small, this chemotherapy is a useful regimen for induction therapy in children with an aggressive deep-seated pilocytic astrocytoma.

Combined surgical and endovascular treatment of infected pseudoaneurysm after carotid endarterectomy. Case report.

A 67-year-old male presented with a rare pseudoaneurysm caused by infection after carotid endarterectomy (CEA) performed for stenosis of the left internal carotid artery (ICA). Wound infection and recurrent bleeding from the operated ICA developed 1 month after surgery. Serial angiography showed that the post-CEA pseudoaneurysm gradually increased in size. The carotid balloon occlusion test revealed that the patient could not tolerate permanent ICA occlusion because of poorly developed collaterals. Direct surgical exposure of the aneurysm was impossible due to tight adhesion of the surrounding tissue, so common carotid to middle cerebral artery bypass using a radial artery graft was performed followed by ligation of the distal common carotid artery. Subsequently, retrograde blood flow from the ICA to the aneurysm was interrupted by embolization of the external carotid artery coil through the facial artery. Combined surgical and endovascular treatment is a therapeutic option for patients with post-CEA pseudoaneurysm, if either direct or endovascular surgery is unfeasible.

[A case of lymphocytic hypophysitis mimicking pituitary macroadenoma].

Lymphocytic hypophysitis is a rare autoimmune disease of the pituitary gland mimicking pituitary macroadenoma on magnetic resonance imaging (MRI). We encountered a 32-year-old female who presented with a typical pituitary macroadenoma causing sudden on-set of visual disturbance during her second pregnancy. She underwent an endonasal-transsphenoidal resection of the mass diagnosed as a non-secreting pituitary macroadenoma after a cesarean operation. Intraoperatively, the lesion was found to be extremely tough and mucinous, and apparently differed from pituitary adenoma. The frozen section revealed hypophysitis and we performed only a biopsy of the mass. Histopathological examination showed diffuse infiltrate of non-specific lymphocytes. Postoperatively, prednisolone was given for two weeks, her visual disturbance improved with radiologically marked shrinking of the lesion. This case illustrates the difficulty of differentiation of lymphocytic hypophysitis from pituitary macroadenoma, and we discuss the clinical features and the management of this disease.

Intraparenchymal meningioma in a child.

A 10-year-old boy presented with an intraparenchymal meningioma, which had no attachment to the dura, manifesting as grand-mal seizure. Neurological examination showed no abnormalities. Magnetic resonance (MR) imaging revealed a round, well demarcated mass in the left frontal lobe, which was homogeneously enhanced. The tumor appeared to be intraaxial and caused marked peritumoral white matter edema. At operation, the mass was totally embedded in the frontal lobe and gross total resection was accomplished. The histological diagnosis was meningothelial meningioma with chordoid components in World Health Organization grade I. His postoperative course was uneventful and postoperative MR imaging revealed no residual tumor. Intraparenchymal meningioma should be considered in the differential diagnosis of an intraaxial lesion in a child.

A case of pulmonary sclerosing hemangioma surrounded by giant cystic change on high-resolution computed tomography.

Pulmonary sclerosing hemangioma is a rare benign neoplasm, usually presenting as a well-defined round or oval mass. We report a case of pulmonary sclerosing hemangioma surrounded by an unusual giant cystic change on high-resolution computed tomography, which led to the suspicion of this tumor.

Ruptured distal anterior inferior cerebellar artery aneurysm following stereotactic irradiation for vestibular schwannoma: case report.

A 73-year-old woman presented with diffuse subarachnoid hemorrhage from a ruptured fusiform aneurysm directly arising from the right distal anterior inferior cerebellar artery. Six years before admission, she had undergone stereotactic irradiation for right vestibular schwannoma, under a diagnosis based on neuroimaging. The aneurysm was located within the radiation field. We performed trapping and resection of the aneurysm via a right lateral suboccipital craniotomy, and the patient made a good recovery. Histological examination revealed no evidence of elastic lamina in the aneurysm wall, suggesting pseudoaneurysm caused by radiation-induced vascular injury. Aneurysm formation after radiotherapy is relatively rare and often manifests as fatal hemorrhage. Long-term surviving patients who have received intracranial irradiation should undergo sequential follow up for possible vascular involvement.

Immature NK cells suppress dendritic cell functions during the development of leukemia in a mouse model.

To analyze the mechanisms by which cancer cells escape from hosts' immune surveillance, we investigated the changes in immune status during the progression of leukemia induced by injecting mice with WEHI-3B cells. In the bone marrow (BM) of leukemic mice, only DX5(+)CD3(-) cells were continuously increased, despite the progression of leukemia. In addition, DX5(+)CD3(-) cells were rapidly increased in peripheral blood (PB) 20 days after inoculation. We also found that myeloid dendritic cells (DCs) expressing low levels of I-A(d) and having low allo-T cell stimulatory activity were markedly increased in PB and spleen. The increase in DX5(+) cells in BM was thought to be induced by soluble factors from leukemic cells. DX5(+) cells from leukemic mice were CD3(-), B220(-), Gr-1(-), CD14(-), CD94(-), Ly-49C/F(-), asialo GM1(+), CD25(+), CD122(+), Thy-1(bright), and c-kit(dim) and showed low killing activity against YAC-1 cells, suggesting that those DX5(+) cells were immature NK cells. NK cells from leukemic PB down-regulated the expression of I-A(d) on DCs, an effect mediated by TGF-beta. Moreover, these NK cells significantly suppressed the allo-T cell stimulatory activity of DCs, an effect requiring cell-to-cell contact between NK cells and DCs and thought to involve CD25. Importantly, NK cells from leukemic PB inhibited generation of autotumor-specific CTL induced by DCs in primary MLR or by DC immunization. In conclusion, we identified circulating immature NK cells with immunosuppressive activities. These cells may be important for understanding the involvement of the host immune system during the development of leukemia.

Clinico-pathological features of pilomyxoid astrocytoma of the optic pathway.

Five cases of pilomyxoid astrocytoma (PmA) characterized by a monophasic pattern with a myxoid background were selected for a clinicopathological study from 23 cases previously diagnosed as pilocytic astrocytoma (PA). All PmA patients were either infants or young children (mean age 2.1 years), and all tumors were located in the optic chiasm/hypothalamus region. All cases received chemotherapy, which reduced tumor size, and the location of the tumor became confined to the optic chiasm. In two cases, tumor recurrence occurred 3 and 7 years after chemotherapy. Histology of the recurrent tumors showed the biphasic pattern of classical PA. Hence, we conclude that PmA might be an infantile form of PA and speculate that a subset of PmA in the optic pathway/hypothalamus originates from the optic chiasm, possibly derived from radial glia existing in the embryonic optic chiasm.