[A case of pulmonary metastasis of malignant fibrous histiocytoma with left atrial infiltration via the pulmonary vein].

We report a case of a woman who at age 58 had an operation on the right femur for malignant fibrous histiocytoma (MFH). At age 63, a chest X-ray examination disclosed a tumor shadow, for which we suspected metastasis from the MFH. Chest computed tomography showed that the tumor had infiltrated to the left atrium via the pulmonary vein. We operated on the patient, first dividing the arterial supply to the lower lobe, and then opening the pericardium. We blocked the lower pulmonary vein and left atrium with a Cooley-Dera clamp and resected the tumor. The tumor was polypoid and had invaded the left atrium. Fifteen months after this lung surgery, the patient was diagnosed with a brain tumor, which was resected. Invasive primary lung cancer to the left atrium via the pulmonary vein is common, but metastasis from a sarcoma such as MFH to the left atrium via the pulmonary vein is extremely rare.

Ocular attacks after phacoemulsification and intraocular lens implantation in patients with Behçet disease.

PURPOSE: To elucidate factors related to ocular inflammatory attacks after cataract surgery, limited to a single procedure of phacoemulsification and intraocular lens implantation, in patients with Behçet disease. METHODS: This retrospective study included 12 consecutive patients (16 eyes) with Behçet disease, who underwent phacoemulsification and intraocular lens implantation during 4 years from January 1995 to December 1998 at three institutions. Their medical records were reviewed, and factors related to the ocular attacks were analyzed. RESULTS: Four eyes of 3 patients experienced ocular attacks during 1 year before cataract surgery, while 4 eyes of 4 patients developed ocular attacks during 1 year after the surgery. The development of ocular attacks after cataract surgery was significantly related with the presence of ocular attacks during 1 year before the surgery (p = 0.0286, chi(2) test). The patients' age or gender, the duration of Behçet disease or oral medications for Behçet disease did not show any relationship with the presence or absence of ocular attacks after cataract surgery. The visual acuity improved in all patients after the surgery, including those who developed ocular attacks. CONCLUSIONS: The experience of ocular attacks during 1 year before cataract surgery is related to postoperative ocular attacks. Despite postoperative ocular attacks, phacoemulsification with intraocular lens implantation is a safe procedure to expect a good visual outcome in patients with Behçet disease.

Reduction of systemic and cardiac adhesion molecule expression after off-pump versus conventional coronary artery bypass grafting.

Cardiopulmonary bypass (CPB) and operative trauma are associated with increased expression of proinflammatory mediators. We determined the relative contribution of CPB on activation of cytokines and adhesion molecules in patients undergoing coronary revascularization by comparing them with patients receiving off-pump coronary artery bypass grafting (OPCAB). Twenty-six patients were assigned to either the OPCAB procedure using a suction device and regular sternotomy (n = 13), or were treated conventionally using extracorporeal circulation, blood cardioplegia, and hypothermic arrest (29 degrees C-31 degrees C; n = 13). Systemic levels of TNF-alpha and the soluble adhesion molecules P-selectin and intracellular adhesion molecule 1 (ICAM-1) were assayed. Immunohistochemistry was used to account for cardiac-specific expression of adhesion molecules in interventricular endomyocardial sections. Both systemic and endomyocardial expression of adhesion molecules were lower in the OPCAB group. Coronary revascularization with CPB resulted in a significant higher expression of TNF-alpha, which was associated with P-selectin and ICAM-1 expression. This was accompanied with higher catecholamine requirement in the CPB group in the early postoperative period. Despite comparable surgical trauma, the OPCAB procedure without the use of CPB and cardioplegic arrest significantly reduces systemic and cardiac adhesion molecule expression and catecholamine requirement. Since the clinical course in the early postoperative period was comparable, larger trials are required to select the appropriate patient who benefits most from one or the other treatment regime.

Reduced expression of systemic proinflammatory cytokines after off-pump versus conventional coronary artery bypass grafting.

BACKGROUND: Both cardiopulmonary bypass (CPB) and operative trauma are associated with increased expression of proinflammatory cytokines. We assessed the relative contribution of CPB on activation of various proinflammatory cytokines in patients undergoing coronary revascularization by comparing them with patients receiving coronary artery bypass grafts using off-pump (OPCAB) techniques. METHODS: Twenty-six patients were assigned to either the OPCAB procedure using a suction device and regular sternotomy (n = 13) or were treated conventionally using extracorporeal circulation, blood cardioplegia and hypothermic arrest (29-31 degrees C; n = 13). C-reactive protein and systemic levels of TNF-alpha, TNF specific receptors Rp1 and Rp2, Interleukin-6 (IL-6) and soluble IL-2 receptors (sIL-2r) were assayed by ELISA or EIA. To account for systemic nitric oxide production, total nitrate/nitrite (NOx) was measured using the Griess reaction. RESULTS: Coronary revascularization with CPB was associated with a significant expression increase in the TNF-system and sIL-2r when compared to the OPCAB patients. Although IL-6 expression did not differ between both groups, C-reactive protein levels were significantly lower in the OPCAB group. Moreover, systemic NOx levels as the stable end-product of nitric oxide were lower in the OPCAB group. CONCLUSIONS: The data of the present study indicate that, despite comparable surgical trauma, the OPCAB revascularization procedure without the use of CPB and cardioplegic arrest significantly reduces the systemic inflammatory response syndrome and early catecholamine requirement. This may contribute to improved organ function, subsequently resulting in improved postoperative recovery from surgical revascularization procedures, particularly in critically ill patients.

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.

A girl with Hermansky-Pudlak syndrome.

A young girl with ocular albinism and the Hermansky-Pudlak syndrome is described. Ocular albinism generally occurs in males. In this condition, the pigmentation of the skin and hair is nearly normal, and the melanin pigment abnormality is limited to the eyeballs. The chief complaints are visual disturbance, nystagmus, and photophobia. A 3-year-old girl was recently brought to our hospital with nystagmus, which she had exhibited since the age of 1 year. Funduscopy resulted in a diagnosis of ocular albinism. Further investigations, specifically, microscopy of her platelets, led us to conclude that she had Hermansky-Pudlak syndrome.

[Ocular penetration of dexamethasone sodium phosphate via soft contact lenses].

The ocular penetration of dexamethasone sodium phosphate was measured by HPLC and RIA, and the concentrations in the aqueous humor and iris of a soft contact lens (SCL) group and eyedrop-only group of white rabbits were compared. The efficacy of dexamethasone phosphate eyedrops in eyes of white rabbits with SCL was also investigated using protein in the aqueous humor of the eyes of rabbits with experimental endophthalmitis induced by endotoxin and prostaglandin E2 as an index. The concentration of dexamethasone sodium phosphate transferred to the aqueous humor and irises in the SCL group was significantly higher than that in the eyedrop-only group. SCLs containing dexamethasone sodium phosphate was effective against experimental endophthalmitis, and the protein in the aqueous humor was significantly lower in the SCL group than in the controls.

[Anaphylatoxin in the aqueous humor of rabbit with endotoxin induced endophthalmitis].

Anaphylatoxin-activated complement fragment is an important mediator of inflammation. In this study, trends of anaphylatoxin in clinical and experimental endophthalmitis was evaluated. The level of anaphylatoxin (C3a, C4a and C5a) and protein of human aqueous humor aspirated from patients with senile cataracts before surgery was measured. As a model of acute endophthalmitis, endotoxin-Lipopolysaccharide from E. coli (LPS) was used intravitreously in albino rabbits. The level of anaphylatoxin of aqueous humor was measured by radioimmunoassay. The level of C3a was 44.0 +/- 13.4 ng/ml in aqueous humor of cataract patients. An increase of cell count and protein was demonstrated in the aqueous humor of rabbits 24 hrs after endotoxin injection. The level of C3a increased remarkably with time. It was suggested that C3a in aqueous humor of the rabbit eye with endotoxin-induced endophthalmitis plays an important role in chemotaxis and in mediating the inflammatory process.