An autopsy case of Parkes-Weber syndrome with high-output heart failure: Hemodynamic alterations following treatment for arteriovenous fistulas.

An autopsy case of Parkes-Weber syndrome presenting high-output heart failure in a patient who died at 52 years old, is reported. The patient had a tumor in the right buttock since childhood, that had grown up to a diameter of 40 cm diameter by the age of 43 years when he felt exertional dyspnea and was diagnosed as having high-output heart failure due to arteriovenous fistulas. Embolotherapy was attempted, which relieved the symptoms. After 4 years his heart failure deteriorated. We performed embolotherapy but his condition did not improve. He died 1.5 years later. The autopsy revealed the weight of the heart was 1040 g with abundant subendocardial and interstitial fibrosis. In this patient, the level of output had been over 16 L/min which lasted for nine years. The left ventricular ejection fraction (LVEF) decreased during the first five years. Each embolotherapy reduced the cardiac output (CO), which was achieved by a large decrease in heart rate (HR) and a small increase in stroke volume (SV) i.e. CO = HR × SV, and was reflected in the increase in LVEF. Learning objectives: •Parkes-Weber syndrome has occasionally extensive arteriovenous fistulas in the pelvis that show high-output heart failure.•Treatment of such cases is difficult, but embolotherapy has partial effects on improving hemodynamics.•A long-term high-output state induces interstitial myocardial fibrosis and collagenous subendocardial thickening.

Carcinosarcoma (adenocarcinoma, neuroendocrine carcinoma, undifferentiated carcinoma and chondrosarcoma) of the gallbladder.

We present an extremely rare case of carcinosarcoma with 4 different tumor components in an 88-year-old female. After a diagnosis of acute cholecystitis, we performed percutaneous transhepatic gallbladder drainage in the patient without success, followed by a cholecystectomy and choledocholithotomy. The mass was a 60 × 25 mm polypoid lesion of the gallbladder identified histologically as a carcinosarcoma with adenocarcinoma, neuroendocrine carcinoma, undifferentiated carcinoma and chondrosarcoma components. The biliary-type adenocarcinoma portion exhibited acinar growth patterns with columnar cells having large and markedly hyperchromatic nuclei. These tumor cells were immunohistochemically positive for MUC1 and CDX2. The neuroendocrine carcinoma, small cell type, cells were densely packed and small, with scant cytoplasm, finely granular nuclear chromatin and absence of nucleoli. The mitotic index was high. These tumor cells were immunohistochemically positive for synaptophysin, Ki-67 (index 40%), MUC1, CDX2 and c-Kit. The undifferentiated carcinoma consisted exclusively of spindle cells containing large, markedly hyperchromatic nuclei with a high mitotic index. These tumor cells were immunohistochemically positive for AE1/AE3. The chondrosarcoma was composed of blue-gray chondroid matrix and atypical chondrocytes containing large, hyperchromatic nuclei. These tumor cells were immunohistochemically positive for S100. Its attributes might be suggestive of a greater malignant potential and pathogenesis of carcinosarcoma.

Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer.

AIM: To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors. METHODS: Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis. RESULTS: LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ≤ 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ≤ 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups. CONCLUSION: LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor.

Molecularly designed nanoparticles by dispersion of self-assembled organosiloxane-based mesophases.

The design of siloxane-based nanoparticles is important for many applications. Here we show a novel approach to form core-shell silica nanoparticles of a few nanometers in size through the principle of "dispersion of ordered mesostructures into single nanocomponents". Self-assembled siloxane-organic hybrids derived from amphiphilic alkyl-oligosiloxanes were postsynthetically dispersed in organic solvent to yield uniform nanoparticles consisting of dense lipophilic shells and hydrophilic siloxane cores. In situ encapsulation of fluorescent dyes into the nanoparticles demonstrated their ability to function as nanocarriers.

Direct deposition of trivalent rhodium hydroxide nanoparticles onto a semiconducting layered calcium niobate for photocatalytic hydrogen evolution.

Well-dispersed Rh(OH)3 nanoparticles were deposited in the interlayer galleries of a Dion-Jacobson type layered perovskite (ACa2Nb3O10: A=H or K). X-ray photoelectron spectra and zeta potential measurements suggest covalent bonding (Rh-O-Nb) between the nanoparticles and the niobate sheets. After calcination of Rh(OH)3/KCa2Nb3O10 at 350 degrees C in air, interlayer Rh(OH)3 nanoparticles were transformed to Rh2O3 and showed higher photocatalytic activity for hydrogen evolution using methanol as a sacrificial electron donor.

Anodic electrodeposition of highly oriented zirconium phosphate and polyaniline-intercalated zirconium phosphate films.

Films of highly oriented alpha-zirconium phosphate and polyaniline-intercalated zirconium phosphate with controllable thickness in the micrometer range were grown anodically on Pt electrodes. To optimize the electrodeposition conditions, the exfoliation of alpha-zirconium phosphate by tetrabutylammonium (TBA) salts was investigated in several nonaqueous solvents. Acetonitrile was found to be the best solvent for making crack-free, oriented films because of its high vapor pressure, low viscosity, and relatively high permittivity. With TBA salts of neutral or weakly acidic anions (TBACl, TBABr, TBAI, TBA(HSO4), or TBA(H2PO4)), full exfoliation did not occur and alpha-zirconium phosphate and/or polyaniline were deposited as rough films. With basic anions (TBAF or TBAOH), dense, adherent films were obtained. X-ray diffraction patterns of the films showed that they were highly oriented along the stacking axis. The thickness could be controlled, up to about 40 microm, by limiting the time of the electrodeposition reaction. At monomer concentrations below 1.0 x 10(-2) mol/dm3, the emeraldine form of the intercalated polymer was obtained. Electrodeposition thus provides a thick film alternative to layer-by-layer assembly for intercalation compounds of alpha-zirconium phosphate with a conducting polymer.