Cryptococcal necrotizing fasciitis in a patient after renal transplantation--a case report.

A 50-year-old man, who had received an ABO-incompatible living related preemptive renal transplantation 1 year before, presented with painful lesions on both lower extremities and fever. At first, bacterial cellulitis was suspected and antibiotic therapy was initiated, but it was not effective. The serum cryptococcal antigen titer was 1:4,098, and pathologic examination of debrided tissue and wound pus culture revealed cryptococcal necrotizing fasciitis. Liposomal amphotericin B and fluconazole were started, and repeated debridement and skin grafting were performed. Because his graft function deteriorated because of antibody-mediated rejection and polyoma viral nephropathy, hemodialysis was induced on day 9 of hospitalization. During the treatment, he suffered repeated urinary tract infections, which were treated with antibiotics, and cytomegalovirus retinopathy, which was treated with ganciclovir. His cryptococcal necrotizing fasciitis was successfully cured by the combination of antimicrobial treatment and surgical procedures. He could walk with a cane and was discharged on day 298 of hospitalization. Cryptococcal necrotizing fasciitis in renal transplant recipients is so rare that only 14 cases have been reported. The mortality is not very high, but the prognosis of the patient is complicated by worsening of the cryptococcal infection of the central nervous system (CNS). Early detection and treatment to prevent spreading to other sites, especially the CNS or disseminated disease, is very important in cases of cryptococcal necrotizing fasciitis.

Long-term renoprotective effect of candesartan in renal transplant patients.

BACKGROUND: The renoprotective effects of angiotensin II type 1 receptor blockers (ARBs) have been demonstrated in a number of clinical studies, but there are few evaluations of long-term ARB treatment. We measured blood pressure, urine protein, and estimated glomerular filtration rate (eGFR) among patients under long-term (up to 9 years) treatment with candesartan cilexetil to evaluate its safety and effectiveness to protect renal graft function. METHODS: This study of 41 patients (31 male and 10 female) who presented with proteinuria and hypertension (blood pressure >140/90 mm Hg) after receiving a renal graft. Their serum creatinine level at baseline was 1.51 ± 0.53 mg/dL. Cyclosporine or tacrolimus were concomitantly prescribed for 18 (43.9%) and 22 (53.7%) subjects, respectively. The ARB treatment period was ≥12 months (up to 9 years, mean 4.8 years). Combination with other antihypertensive drugs (calcium antagonists) was necessary in 14/41 subjects (34.1%). RESULTS: Significant declines in blood pressure were observed during the treatment period; blood pressure reduction target (blood pressure <130/80 mm Hg) was met in 56.1% for systolic and 68.3% for diastolic pressure. No significant increase in serum creatinine level or eGFR was observed. Urinary protein was reduced to negative or marginal in 63.4% of the subjects, demonstrating a significant decrease. CONCLUSIONS: Candesartan cilexetil was considered to be safe even for long-term treatment in renal transplant patients, and effective to protect renal graft function.

Functionalization of octavinylsilsesquioxane by ruthenium-catalyzed silylative coupling versus cross-metathesis.

Functionalization of octavinylsilsesquioxane (Vi(8)T(8), 1) by two reactions catalyzed by ruthenium complexes is reported: a silylative coupling reaction catalyzed by [RuHCl(CO)(PCy(3))(2)] (I) and cross-metathesis catalyzed by first- (II) and second-generation (III) Grubbs' catalysts. The two reactions of 1 with styrene take place highly regio- and stereoselectively (the X-ray structure of the product 2 has also been obtained); the cross-metathesis of 1-hexene and allyltrimethylsilane occurs quite effectively, whereas the silylative coupling with these compounds gives a mixture of isomers. Functionalization of 1 with heteroatom-substituted vinyl derivatives (Si, O, N) by silylative coupling reaction has been found to be highly efficient, but cross-metathesis appears to be the more effective method for the synthesis of S-substituted vinyl-silsesquioxane.

Preparation of L-talose and D-gulose from L-tagatose and D-sorbose, respectively, using immobilized L-rhamnose isomerase.

L-rhamnose isomerase of Pseudomonas sp. LL172 immobilized on BCW 2603 Chitopearl beads was used to produce L-talose and D-gulose. At equilibrium, the production yields of L-talose and D-gulose were determined to be 12 and 10% from L-tagatose and D-sorbose, respectively. The crystallized products were confirmed by HPLC, IR and NMR spectra, and optical rotation measurement analyses.

A clinical study of the results of cementless total hip replacement.

We introduce our total hip prosthesis, its operation technique, and report the clinical results. Ours does not use bone-cement, but its design, together with the use of original bone and new bone formation surrounding it, results in a biological anchoring. Since 1978, we developed for this new type of total hip prosthesis 6 sizes of stem to fit more rigidly within the intramedullary canal of femur. The new femoral component also has larger notches on its surface than did the old one. Our results of 144 cases (147 joints) ranging from 2 to 10 postoperative years giving an average of 4.4 years, are quite satisfactory. Blood loss during the operation is as little as 480 ml. The few complications observed differ from those of the Charnley type, and will be reduced greatly when the operation is yet more cautiously and skillfully done. Unilateral replacement in bilaterally affected patients improved the condition of the unoperated side in 30% of the cases.

A cementless system of total hip prosthesis. Experimental studies on total hip prosthesis in dogs.

It is essential that the prosthetic material should not be harmful to the human body, it should be strictly fitted to the body and it should have sufficient durability. To investigate those conditions of an artificial joints as mentioned above, it is important to have experimental studies using a model of the artificial joint in animals instead of a simulator. The authors have developed their own total hip prosthesis for a dog since 1970. These prostheses were fixed to the bone without bone cement. These dogs were killed periodically from 8 weeks to 3 years after surgery of total hip replacement. Not only were pathohistological studies on the joint capsule and bony tissue of the femur surrounding the prosthesis performed, but also scanning electron microscopic examination on capsule and the surface of the prosthetic head were performed. The results were excellent. Ther was no loosening or wear when the new type of acetabular socket with large spikes was used. On the other hand, in the case of the old type socket with its smooth surface and smaller spikes, loosening of the socket and prosthetic stem occurred within one year after surgery.

The direct fixation system of total hip prosthesis. Research of the possibilities of fixing total hip prosthesis directly to bone.

There are two methods for the fixation of prostheses to bone; one is a method using bone cement and another is the direct fixation of the prostheses to bone. Four types of animal experiments were performed to compare the two methods of fixation. A small pyramid shaped test piece was used to compare the fixation capacity of the socket spike. Also, a special test piece was used to study the time of bone formation, to check the fixation capacity of bone bar formation occurring in the hole in the based part of the prosthetic component. furthermore, models of prosthetic stem and socket were made and attached to the femur and ilium of dog to perform fixation tests and fatigue tests. As a result, any of the tests proved that the direct fixation method without the usage of bone cement was superior to the fixation method using bone cement.