Two cases of calcineurin inhibitor-associated reversible posterior leukoencephalopathy syndrome in renal transplant recipients.

Reversible posterior leukoencephalopathy syndrome (RPLS) is one of the important side effects of calcineurin inhibitors (CNIs). Magnetic resonance imaging (MRI) of the brain is useful for the diagnosis of RPLS, showing the edema primarily in the cortex and subcortical white matter of the posterior brain regions. Interruption of CNIs is essential for the treatment of patients with RPLS. Herein we have described 2 cases (1.7%) of RPLS induced by CNIs after kidney transplantation. The first case was a 56-year-old man with chronic renal failure due to diabetic nephropathy who received a living-related kidney transplantation in 2006. Initial immunosuppressive therapy consisted of cyclosporine, mycophenolate mofetil (MMF), prednisolone, and basiliximab. Four months after transplantation, he developed unconsciousness and paralysis. The second case was a 24-year-old woman with end-stage renal disease due to Alport syndrome who received an ABO-incompatible living-related kidney transplantation. Initial immunosuppressive therapy consisted of tacrolimus, MMF, prednisolone, and basiliximab. On postoperative day 3, she developed convulsions and unconsciousness. In both patients, RPLS was diagnosed with neurological symptoms and MRI findings at early stage of the disease, and they recovered rapidly from the disease by the interruption of CNIs. Our data demonstrated that early diagnosis and immediate interruption of CNIs were essential for the treatment of RPLS after kidney transplantation.

Preduodenal portal vein in the adult.

Preduodenal portal vein (PDPV) is a rare developmental anomaly. We recently encountered this anomaly in a 73-year-old woman who had gastric cancer and colonic cancer with liver metastasis. The PDPV was diagnosed preoperatively by computed tomography and angiography. To the best of our knowledge, there are only 19 adult cases reported in the world literature, with this additional case being reported here. In infants the anomaly has often been associated with duodenal obstruction, but in adults it is often symptomless. We discuss the disease process, embryology, diagnosis, association with other anomalies, and surgical treatment.

Expression of c-erbB family gene products in adenoid cystic carcinoma of salivary glands: an immunohistochemical study.

The tyrosine kinase receptor family, including the epidermal growth factor receptor (EGF-R), c-erbB2 and, more recently, the c-erbB3, has been recognized as being of particular importance in many human malignancies. This study was undertaken to define the role of c-erb B2 and c-erbB3 in adenoid cystic carcinomas (A.C.C.) of the salivary glands. Sixteen cases of A.C.C. were studied immunohistochemically, using antibodies against each erbB gene family product. EGF-R was not detected in any of these samples but c-erbB2 and c-erbB3 gene products (ERBB2and ERBB3) were demonstrated in all A.C.C. sections with some degree of straining. Tubular and cribriform patterns overexpressed particularly large amounts of ERBB2 and ERBB3. Strong staining was mainly demonstrated in tumor cells of the invasive area. These results suggested that overexpression of ERBB2 and ERBB3 is related to tumor differentiation and invasion in adenoid cystic carcinomas.

[A case of acute coronary syndrome followed by 201Tl, 123I-BMIPP and 123I-MIBG myocardial imagings before and after PTCA].

201TlCl (Tl), 123I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) and 123I-metaiodobenzylguanidine (MIBG) images were applied before and after PTCA to a patient with acute coronary syndrome who had repeated ischemic attacks on light effort. A decreased tracer uptake was noted at the mid and apical anteroseptal regions in each image before PTCA. MIBG uptake was most decreased and Tl uptake was least decreased, but Tl uptake at exercise decreased as severely as MIBG uptake at rest. After PTCA an uptake was improved in each image. Both before and after PTCA, the area with decreased BMIPP uptake corresponded to the region with deteriorated wall motion obtained by echocardiography. It was suspected that the decreased MIBG uptake correlates with "area at risk" and that the decreased BMIPP uptake correlates with abnormal wall motion. Taken together those findings, it was indicated that an application of these cardiac scintigraphy is useful for the evaluation of comprehending metabolic abnormality and recovering process of ischemic myocardium.

[Assessment of reverse redistribution on exercise 201Tl myocardial SPECT in patients with hypertrophic cardiomyopathy].

Reverse redistribution is revealed on exercise 201Tl myocardial SPECT in some cases with hypertrophic cardiomyopathy. Ten patients with hypertrophic cardiomyopathy without coronary artery disease who showed reverse redistribution visually were studied. Reverse redistribution was evaluated by the early and delayed images of exercise 201Tl myocardial SPECT. Relation between reverse redistribution and distribution of left ventricular hypertrophy estimated by echocardiography and magnetic resonance imaging was investigated, and the mechanism of reverse redistribution was analyzed by referring to Bull's eye display of washout rate. Reverse redistribution was displayed in non-hypertrophic region and washout rate was normal in that region and low in hypertrophic region. In conclusion, in order to interpret reverse redistribution it is necessary to recognize hypertrophic region and to refer to washout rate.

[Effect of verapamil on myocardial ischemia in patients with hypertrophic cardiomyopathy: evaluation by exercise 201Tl SPECT].

Effect of verapamil on myocardial ischemia in patients with hypertrophic cardiomyopathy (HCM) was evaluated by exercise stress myocardial 201Tl SPECT (EX-Tl). EX-Tl were performed before and after 8.8 weeks of oral verapamil (240 mg/day) in 12 patients with HCM who showed transient 201Tl perfusion defects under control conditions. 201Tl perfusion defect was visually scored and judged for 4 grades as normal (0), mild defect (1), moderate defect (2), and severe defect (3). Transient Dilation Index (TDI) was calculated as an index of subendocardial ischemia. Improvements of defect score were demonstrated in 10 patients after administration of verapamil. Two patients showed no change of defect score. Mean defect score decreased significantly from 5.50 to 3.03 (p < 0.001). Although 11 of 12 patients showed abnormal TDI under control conditions, 10 of them revealed improvements of TDI and 7 of those 10 patients disclosed normal TDI after verapamil. Mean TDI decreased from 1.263 to 1.090 significantly (p < 0.01). In conclusion, verapamil may improve myocardial ischemia in patients with HCM.

[Effects of aging on fluorescein iris and angle photography in normal subjects].

In the present study we took the fluorescein iris and angle photography of normal eyes and studied them according to different age groups. The range of age in 108 eyes of 92 subjects was from 20 to 93 years. They were free from any systemic diseases or ophthalmic diseases which would cause iris rubeosis. Fluorography was carried out using a Mizuno Trabeculens to determine the leakage points of fluorescence from the iris and the angle. In the angle there were gonio vessels which revealed no leakage of fluorescein. They were observed in 8 of 30 eyes (27%) for subjects in the fifth decade of life or less and in 24 of 78 eyes (31%) for subjects aged 50-90. No significant difference was seen between the two age groups. As to variations of gonio vessels, radial ciliary body vessel was found in 23 eyes, radial iris vessel or trabecular vessel in 10 eyes, and circular ciliary band vessel in 7 eyes. In the pupillary margin no leakage was seen in 30 eyes of 30 cases in the fifth decade of life or less, while leakage was found in 33 of 78 eyes, 42 of 62 cases over the fifth decade of life. In the angle leakage was seen in 4 of 30 eyes, 13 of 30 cases in the fifth decade of life or less, while leakage was observed in 43 of 78 eyes over the fifth decade of life. These results suggested that leakage of fluorescence from the pupillary margin, the angle or both increases with age.(ABSTRACT TRUNCATED AT 250 WORDS)