Clinical relationship between histopathological necrotic/partial necrotic findings and disease condition of gallbladder mucoceles in dogs.

Gallbladder mucocele (GM) is a common extrahepatic biliary disease recognized in dogs and is defined as the expansion and extension of the gallbladder by an accumulation of semi-solid bile or bile acid. Histopathological diagnosis of necrotizing cholecystitis and transmural coagulative necrosis of the gallbladder wall shows poor prognosis. Conversely, histopathological diagnosis with partial necrotic findings is often achieved. We hypothesized that histopathological partial necrosis of the gallbladder wall is the primary lesion of necrotic cholecystitis or transmural ischemic necrosis. Therefore, we investigated the relationship between histopathological necrosis/ partial necrosis findings and their clinical conditions. We retrospectively analyzed 55 dogs diagnosed with GM that had undergone cholecystectomy at the Yamaguchi University Animal Medical Center. The group with histopathological necrosis/partial necrosis of the gallbladder wall showed elevated levels of preoperative white blood cells, alanine transaminase, alkaline phosphatase, γ-glutamyltransferase, total bilirubin, and C-reactive protein compared to the non-necrotic group. Partial necrosis of the gallbladder wall may affect the progression of the disease and hematological abnormalities. Additionally, all death cases until 2 weeks were included in the histopathological necrosis/partial necrosis group. In this study, we found that poor prognosis factors were associated with partial necrosis of the gallbladder wall. Furthermore, these cases of partial necrosis showed elevated levels of blood test parameters. These results suggest that necrosis of the gallbladder wall is associated with poor prognosis and poor pathophysiological conditions.

A Comparison of the Regional Circulation in the Feet between Dialysis and Non-Dialysis Patients using Indocyanine Green Angiography.

BACKGROUND AND AIMS: Peripheral artery disease in dialysis cases is more prone to critical limb ischemia compared to non-dialysis cases, with a significantly high rate of major amputation of the lower limbs. Lesions are distributed on the more distal side in dialysis critical limb ischemia cases. The aim of this study was to investigate the usefulness of indocyanine green angiography to determine differences in the regional circulation in the foot between dialysis and non-dialysis patients. MATERIALS AND METHODS: The subjects included 62 cases, among which 20 were dialysis patients and 42 were non-dialysis patients. We compared the indocyanine green angiography parameters for regions of interest in the dialysis and non-dialysis groups, which included the magnitude of intensity from indocyanine green onset to maximum intensity (Imax), the time from indocyanine green onset to maximum intensity (Tmax), the time elapsed from the fluorescence onset to half the maximum intensity (T1/2), and the time from maximum intensity to declining to 90% of the maximum intensity (Td90%). These indocyanine green angiography parameters were measured at region of interest 1 (the Chopart joint), region of interest 2 (the Lisfranc joint), and region of interest 3 (the distal region of the first metatarsal bone). RESULTS: In the comparison between the dialysis and non-dialysis groups, a significant difference was observed regarding Tmax, T1/2, and Td90%, especially in region of interest 3. CONCLUSION: In this study, we show that regional tissue perfusion is more deteriorated in dialysis patients compared with non-dialysis patients using indocyanine green angiography. Tmax, T1/2, and Td90% could be useful clinical parameters to compare ischemic severity of the lower limb between dialysis and non-dialysis patients.

Quantitative evaluation of the outcomes of revascularization procedures for peripheral arterial disease using indocyanine green angiography.

OBJECTIVES: We performed indocyanine green angiography (ICGA) in patients with peripheral arterial disease (PAD), and established a method for the quantitative measurement of appropriate parameters to assess peripheral perfusion and the applicability of ICGA tests. METHODS: Twenty-one patients with PAD underwent revascularization procedures with pre- and postinterventional ICGA tests. The ICGA parameters, which included the magnitude of intensity of indocyanine green, the time to maximum intensity, and the time from fluorescence onset to half the maximum intensity (T1/2) were compared with the ankle-brachial pressure index, toe -brachial pressure index, and toe pressure. We evaluated these parameters for regions of interest (ROIs). RESULTS: T1/2 was the strongest parameter among all parameters of the ICGA tests. ROI 3, which included the distal region of the first metatarsal bone, correlated more significantly with the traditional measurements than the other ROIs. A value of T1/2 >20 seconds for ROI 3 was significantly correlated with a toe pressure of <50 mmHg (sensitivity: 0.77, specificity: 0.80). CONCLUSIONS: ICGA can be used to assess peripheral tissue perfusion. By measuring the value of T1/2 in ROI 3, ICGA tests can be used to evaluate the outcomes of revascularization procedures.

Successful endovascular repair of ruptured isolated bilateral internal iliac artery aneurysms.

INTRODUCTION: Due to their anatomic location, internal iliac artery aneurysms are difficult to treat surgically. An endovascular approach can be helpful, even in ruptured cases. REPORT: We report a 71-year-old male with ruptured isolated bilateral internal iliac artery aneurysms. The aneurysms were treated with embolisation of the branching arteries of the bilateral internal iliac arteries followed by placement of a stent graft covering the orifice of the bilateral internal iliac arteries. The patient tolerated this procedure well. DISCUSSION: Even in patients with ruptured aneurysms, endovascular treatment for internal iliac artery aneurysms can be a good treatment option.

Drainage surgery followed by postoperative irrigation with gentian violet for prosthetic graft infection caused by methicillin-resistant Staphylococcus aureus.

INTRODUCTION: Infection of a prosthetic graft is still associated with considerable morbidity and mortality. Conventionally, this vascular complication is treated by excising the infected graft, although prosthetic graft preservation is possible in selected cases. REPORT: We report the successful treatment of prosthetic graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in three patients, by performing drainage surgery with postoperative irrigation using gentian violet. DISCUSSION: The combination of drainage surgery and irrigation with gentian violet solution provides an alternative option to graft excision for prosthetic graft infection.

Clinical presentation of obturator hernia and review of the literature.

PURPOSE: Obturator hernia (OH) is a rare type of pelvic hernia. As the symptoms are nonspecific and the physical findings are obscure, a correct diagnosis is often delayed until laparotomy for bowel obstruction, despite advances in diagnostic modalities. The high postoperative mortality rate is often attributed to the delay in diagnosis. This article aimed to review the diagnosis and management of OH patients at our hospital, by describing the clinical presentation, diagnostic modalities, and management. METHODS: We reviewed ten patients who underwent surgery for an OH within a 5-year period, all of whom were elderly, thin, and parous women. RESULTS: A correct preoperative diagnosis based on computed tomography (CT) findings was made in all ten patients. All of the patients survived, but three suffered postoperative complications. CONCLUSIONS: Based on our experience, when an elderly, thin, and parous woman presents with vomiting, abdominal or thigh pain, and intestinal obstruction, the differential diagnosis should include OH. Early diagnosis and prompt initiation of treatment reduces the risk of surgical complications and increases the chance of survival.

A case of Coffin-Lowry syndrome with premature exfoliation of primary teeth.

We present a case of a 5-year-old boy with premature exfoliation of primary teeth. All eight primary incisors had exfoliated by the age of 3 years, and three canines and one primary first molar were subsequently lost when he was 4 years old. None of the exfoliated teeth exhibited caries. The boy also showed characteristic facial changes, tapering of the fingers, and mental and motor retardation. Based on these findings, he was diagnosed as having Coffin-Lowry syndrome. Premature exfoliation of primary teeth in Coffin-Lowry syndrome has been described in a few reports. This manifestation of the disease would be helpful for diagnosis at an early stage as those previous reports suggested.

[Influence on diagnosis of Helicobacter pylori infection in 13C urea breath test of existence of dead space gas].

The 13C-urea breath test is a noninvasive analysis for the detection of Helicobacter pylori infection and is valuable for judging the effects of antimicrobial treatment. Up to date the most popular technique for 13C-urea breath test: UBT, is performed by collecting expired gas into an aluminum bag, but the result is considered to be influenced in the diagnosis of Helicobacter pylori infection by the existence of anatomical dead space gas. We therefore introduced a new technique to measure 13CO2 and 12CO2 continuously during expiration, identified the correct alveolar gas, and excluded the effect of anatomical dead space. Subjects were 127 males and 8 females. We compared the diagnostic accuracy of these aluminum bag and continuous measurement methods. We adopted serological IgG positive and barium-meal study positive cases as a gold standard for the diagnosis. Diagnostic accuracy by continuous measurement was superior to that by the aluminum bag method. We should pay attention to the existence of anatomical dead space for accurate diagnosis. Continuous measurement is important in the collection of end tidal expired gas in order to make an accurate diagnosis.

[Evaluation of preventive dental care for first permanent molars in children].

The prevalence of dental caries in first permanent molars was measured in 220 children who have been under regular dental care at the Pediatric Dental Clinic, Tohoku University School of Dentistry. While the caries prevalence rate of first permanent molars reached approx. 50% five years after the eruption, the number of filled surfaces per restored tooth was less than 2.0. The caries prevalence of the permanent mandibular first molars was significantly higher than the caries prevalence of the permanent maxillary first molars. However, the occlusal surface showed no significant differences between the maxillary and mandibular molars. While comparing the female to male group, the caries prevalence rate was significantly higher and the peak of caries occurrence on every surface was earlier in the females. Pit and fissure sealants were applied to approx. 75% of first permanent molars and the occlusal caries were reduced as a result of sealing. When sealants were applied to the teeth diagnosed as C1, 50% were restored due to development of caries. This was a significantly higher rate than that applied to sound teeth. Our study indicates that most of the occlusal caries occurred in the earlier stage of 1-2 years after the eruption, before sealants were applied. The buccal fissure of the lower molars and the occlusal fissures both showed high caries prevalence. It was suggested that prevention of fissure caries immediately following eruption until the sealant is applied is an important issue in our present dental care system.

[Changes of the arch form and occlusion of the deciduous open bite cases: a longitudinal study].

The purpose of this study was to determine the characteristics and longitudinal changes of the arch morphology and occulusion of the deciduous open bite cases. The materials used in this study were the serial plaster casts of 40 Japanese children with deciduous open bite, and they were measured with the three dimentional system. The following results were obtained: 1. The form of dental arch with open bite in the early primary dentition changed remarkably in the maxilla but little in the mandible. In children with open bite, the maxillary intercanine distance was narrower, the maxillary arch length was longer, the palatal height of the front area was higher, but the back one was lower, and the upper central primary incisors were located more forward and upward higher than in children without open bite. 2. In the late primary dentition, the dental arch shape in the spontaneous closure group showed little difference from the control group. However the deciduous upper central incisors of the spontaneous closure group were very remarkably inclined to the palatal side, and the vertical over-jet was larger than that in the control group. The larger the horizontal over-jets were in the early deciduous dentition, the larger the vertical over-jet changed in the late deciduous dentition. 3. In the spontaneous closure group, the point of the dental arch showed a regular changing aspect, in which place marked variation was recognized in the early deciduous dentition as compared with the control group. Because of spontaneous closure, the dental arch shape approached the one of control group rapidly. 4. The result of multivariate analysis indicate that not only discontinuance of thumb-sucking but also many variables of the dental arch shape and occlusal condition may induce spontaneous closure of the open bite within the deciduous dentition term.