A new umbilicoplasty for children: creating a longitudinal deep umbilical depression.

When forming a deep umbilical depression for paediatric patients displaying a thin layer of abdominal fat, the V-Y advancement flap method is useful. However, although many plastic surgeons approve of a longitudinal umbilical depression as an ideal, conventional flap methods often result in only a longitudinal scar line with a depression at the end of the scar. The shifted umbilical depression facing upward or downward appears aesthetically unnatural. To resolve these problems, we have devised a new method of umbilicoplasty. Using obliquely opposing flaps, a longitudinal deep umbilical depression facing forward can be created at the correct umbilical position.

Silver(I)-catalyzed asymmetric Mukaiyama aldol reaction

Cationic Ag(I)-BINAP complex has been shown to be an effective catalyst for Mukaiyama aldol reaction between aldehyde and silyl enol ether derivatives. AgPF6-BINAP is very active in this reaction and can achieve high enantiomeric excess under mild conditions. Addition of a small amount of water enhanced the reactivity to suggest the contribution of enolate anion intermediate. AgOAc-BINAP, which in noncationic species, showed an extraordinary high activity although %ee was low.

Acute lung injury after inhalation of water-proofing spray while smoking a cigarette.

A 34-year-old Japanese woman developed acute lung injury soon after inhaling a water-proofing spray which she applied onto her ski suit while smoking a cigarette at the same time. She initially demonstrated arterial hypoxemia (PaO2 = 59 mm Hg) and ground-glass opacities in both lung fields on the CT scan, which both returned to normal without any medication. Several water-proofing sprays, which are easily obtainable in Japan, contain 1,1,1-trichloroethane, liquefied petroleum gas and fluoride resin. Although these components have not been reported to be toxic to the lung yet, high concentrations of these components and/or the pyrolytic products of fluoride resin may have caused acute lung injury in this case.

[Chronic hypersensitivity pneumonitis due to isocyanate in a patient presenting with acute symptoms 1 month after environmental exposure].

A 51-year-old man who had been working for 10 years with polyurethane paint containing isocyanate (MDI) was admitted to our hospital with complaints of fever and exertional dyspnea. Fine crackles were heard in both bases, and the patient had clubbed fingers. A chest X-ray film and computed tomograms of the lungs revealed patchy infiltrative shadows in both lung fields and subpleural honeycombing associated with irregular linear areas. Examination of bronchoalveolar lavage fluid showed increased T lymphocytes and a decreased CD 4/8 ratio. Specimens obtained by transbronchial lung biopsy revealed lymphoplasmacytic infiltration into the thickened alveolar walls, macrophage accumulation, and micro-epithelioid cell granulomas in the alveolar sacs. Hypersensitivity pneumonitis was suspected although the causative antigen was not identified because the results of short-term environmental provocation tests were negative in the patient's home and workplace. After discharge, the patient continued working as a paint sprayer. His acute symptoms recurred 1 month after exposure to isocyanate. Similar episodes occurred on two separate occasions. In addition, the patient tested positive for antibody to MDI-HSA in bronchoalveolar fluid. From the above observations, the patient was given a diagnosis of chronic hypersensitivity pneumonitis due to isocyanate (MDI). This condition is extremely rare. Furthermore, it is interesting that acute symptoms recurred 1 month after environmental exposure to the causative antigen.

[An elderly woman with chronic pigeon-breeder's disease].

A 64-year-old woman had been feeding more than 60 pigeons in a coop in her back yard for 35 years. Diffuse reticulonodular shadows were found on a chest radiograph obtained as part of an annual check-up eight years before admission to the hospital. She was given a tentative diagnosis of idiopathic pulmonary fibrosis and was observed. She was admitted to our hospital because she noticed dry coughing and shortness of breath. A chest CT scan revealed segmentally distributed honeycombing and bronchi-bronchioloectasis. Tests for IgA and IgG antibodies to extracts of pigeon droppings in serum samples and in samples of bronchoalveolar lavage fluid were strongly positive, as were tests for lymphocyte blastogenic responses to samples of pigeon serum Examination of lung-biopsy specimens obtained by video-assisted thoracoscopic surgery revealed bronchiolitis, alveolitis, and honeycombing in a centrilobular distribution. The patient was given a diagnosis of pigeon-breeder's disease. Chronic hypersensitivity pneumonitis without acute episodes might be misdiagnosed as idiopathic interstitial pneumonia or bronchiectasis, as happened in this case. The possibility of chronic hypersensitivity pneumonitis should be considered when patients are suspected to have pulmonary fibrosis. It is important to obtain the detailed information on past or current avian contact, working history, and the home environment.

[Bronchial cyst in a patient with a high serum CA19-9 concentration that fluctuated with the cyst fluid volume].

A 44-year-old woman was found to have an abnormally high concentration of CA19-9 in serum. Five years later, she underwent a right upper lobectomy for an abnormal shadow on a chest roentgenogram, because it was thought to indicate a malignant tumor. A chest CT scan revealed a cyst with fluid in the right upper lobe. During the 5 years before the lobectomy, the serum CA19-9 concentration rose when the cyst fluid volume increased, and fell when the cyst fluid volume decreased. Before the operation, the serum CA19-9 concentration was very high and the cyst was swollen. The cyst wall was found to be lined with ciliated columnar epithelial cells and to contain hyaline cartilage and smooth muscle, which led to the diagnosis of bronchial cyst. The surface epithelium and cyst fluid were positively stained by a monoclonal antibody against CA19-9. The serum CA19-9 concentration decreased and was within the normal range 3 months after the operation.