The Improvement of Dry Eye Symptoms after Pinguecula Excision and Conjunctival Autograft with Fibrin Glue.

PURPOSE: To evaluate the association between pinguecula excision and subsequent improvement in dry eye syndrome. METHODS: We included 30 consecutive patients with primary nasal pinguecula and dry eye symptoms undergoing ocular surgery for the first time. Criteria for pinguecula excision surgery were nasal location, yellowish color, and protrusion of conjunctiva at least 2 times thicker than adjacent normal conjunctiva as measured by anterior segment optical coherence tomography. Our primary outcomes were 3-month postoperative changes in tear film breakup time (TBUT), Schirmer test, and a dry eye symptom score. RESULTS: 30 eyes from 30 different patients (12 men and 18 women) underwent pinguecula excision and conjunctival autografting using fibrin glue. The mean age was 42.5 ± 8.35 (range 28-63) years. The preoperative protrusion ratio of pinguecula was 2.33 ± 0.28 (range 2.00-2.90). Mean preoperative TBUT, Schirmer test, and dry eye symptom scores were 5.10 ± 1.27 seconds, 6.07 ± 2.27 mm, and 2.80 ± 0.76 points. Mean postoperative 3-month TBUT, Schirmer test, and dry eye symptom scores were 7.80 ± 1.13 seconds, 7.27 ± 2.02 mm, and 0.30 ± 0.47 points, respectively. The median pre- and postoperative changes were found to be statistically significant by Wilcoxon signed-rank tests for TBUT, Schirmer test score, and dry eye symptom score. CONCLUSION: Surgical excision of pinguecula and conjunctival autograft using fibrin glue is an effective and safe method to improve symptoms of dry eye syndrome.

Sonographic diagnosis of thyroid metastasis from hepatocellular carcinoma.

Metastasis to the thyroid is very rare in hepatocellular carcinoma (HCC) and only a few cases have been reported. Herein, we report a rare case of metastatic HCC to the thyroid in a 63-year-old man and discuss the various radiologic findings. Computed tomography (CT) revealed a heterogeneous enhancing mass that had invaded the thyroid cartilage in the left upper thyroid, compressing the airway. Ultrasonography (US) showed a heterogeneous hypoechoic mass with increased vascularity in the peripheral portion. The mass showed focal intense uptake on positron emission tomography-computed tomography (PET-CT). The patient underwent US-guided core needle biopsy and the final diagnosis was metastatic HCC.

Bacterial Ulcerative Esophagitis in an Immunocompetent Patient.

Bacterial esophagitis is a very rare condition usually occurring in patients with immunosuppression. To our best knowledge, bacterial esophagitis without underlying immunosuppressive disease has not been reported. We report an immunocompetent patient with bacterial esophagitis caused by B-hemolytic Streptococcus which resulted in an esophageal stricture. A 68-year-old female was admitted for odynophagia which had developed several days before. Upper endoscopy revealed extensive ulceration covered by whitish exudates with submucosal edema at the proximal esophagus. She was treated with steroids and empirical broad-spectrum antibiotics. Within 14 days the symptoms improved. Since growth of B-hemolytic Streptococcus was detected in nasal smear culture, bacterial esophagitis was suspected. Gram staining was carried out on the already obtained tissue that had been fixed with formalin. There was heavy infiltration with gram-positive cocci morphologically consistent with Streptococcus. Since the bacterial colony was demonstrated histologically, the diagnosis of bacterial esophagitis caused by B-hemolytic Streptococcus was confirmed. In addition, complete resolution of the inflammation following antibiotics therapy was further evidence of the bacterial cause of the esophagitis.

A Novel Surgical Approach for Oculodermal Melanocytosis: Superficial Sclerectomy.

OBJECTIVE: To report the outcomes of a new surgical method for oculodermal melanocytosis (nevus of Ota)-superficial scleral separation. METHODS: Twenty-five eyes of 25 patients with scleral pigmentation arising from oculodermal melanocysis. These patients underwent superficial scleral separation between March 2012 and February 2013. Each patient was evaluated with the followings: ocular examinations, the preoperative extent of scleral involvement of nevus of Ota, satisfaction score after surgery, histologic examination, and postoperative complications. Main outcome measures were best-corrected visual acuity (BCVA), induced refractive error, intraocular pressure (IOP), patient satisfaction scores, and anterior segment photographs. RESULTS: All patients showed cosmetic improvement without any serious complications. Preoperative and postoperative BCVA, IOP, and refractive outcomes did not change significantly. CONCLUSIONS: Superficial scleral separation is an effective procedure for cosmetic improvement of oculodermal melanocytosis.

Size dependent macrophage responses and toxicological effects of Ag nanoparticles.

The immune-response of macrophages is an important area of investigation since it represents the major pathway by which early-stage defense barriers are established in skin, lungs, and mucosal systems to counteract foreign objects. In this study, we have examined the size-dependent inflammatory and toxicological effects of nanostructured silver particles (nano-Ag) on macrophage immune cells.

Increased tissue transglutaminase expression in human atherosclerotic coronary arteries.

BACKGROUND AND OBJECTIVE: Transglutaminase 2 (TGase 2) is a calcium-dependent cross-linking enzyme that catalyzes a covalent iso-peptide bond between two proteins. Interestingly, this catalysis can activate the nuclear factor-kappaB (NF-kappaB) through the polymerization of the inhibitory protein of NF-kappaB (I-kappaB). The objective of the present study was to investigate the expression of TGase 2 in the human atherosclerotic human coronary artery, and the possible roles of TGase 2 in NF-kappaB activation. METHODS AND RESULTS: We explored whether expressions of TGase 2 and NF-kappaB are associated in atherosclerosis. Using human samples, we found that TGase 2 was markedly higher than normal in the neointimal tissue of atherosclerotic coronary arteries with atherosclerosis progression. TGase 2 activity was also increased approximately two-fold in the atherosclerotic vascular wall. In immunofluorescence analysis, NF-kappaB, COX-2, and TNF-alpha were co-localized at TGase 2-positive neointimal smooth muscle cells. A promoter assay test showed that NF-kappaB activity increased in both the human monocyte and human breast carcinoma cell by TGase 2, and that TGase 2-mediated NF-kappaB activation was reversed by TGase 2 siRNA. CONCLUSION: According to these results, we suggest that TGase 2 may function as an activator in the NF-kappaB pathway; this effect may occur in the atherosclerotic vessel wall.

Decrease in apoptosis and increase in polyploidization of megakaryocytes by stem cell factor during ex vivo expansion of human cord blood CD34+ cells using thrombopoietin.

Thrombopoietin (TPO) is widely used for ex vivo expansion of hematopoietic stem cells. Previously, we have reported that TPO induces a characteristic pattern of apoptosis, and the TPO-induced apoptosis is closely associated with megakaryocyte (MK) differentiation. In the present study, several cytokines, flt3-ligand, stem cell factor (SCF), interleukin-3 (IL-3), IL-6, IL-11, leukemia inhibitory factor, G-CSF, and erythropoietin, which are known to affect megakaryocytopoiesis, have been evaluated to elucidate their effects on the TPO-induced apoptosis. Measurement of apoptosis by flow cytometry revealed that only SCF absolutely reduced the TPO-induced apoptosis in MK fractions, particularly in the late phase of ex vivo expansion. Platelet production was demonstrated by electron microscopy in a later phase when SCF was added. Simultaneous measurement of DNA contents with immunophenotyping demonstrated a significant increase in polyploidization in the CD41+ cell fraction when cultured with SCF. These results suggested that SCF not only inhibited premature senescence but also enhanced maturation of the differentiating cells of MK lineage during ex vivo expansion using TPO.