Nebulized hypertonic saline in infants hospitalized with moderately severe bronchiolitis due to RSV infection: A multicenter randomized controlled trial.

INTRODUCTION: The efficacy of nebulized hypertonic saline (HS) therapy for shortening hospital length of stay (LOS) or improving bronchiolitic symptoms remains controversial. Most studies enrolled small numbers of subjects and did not consider the role of respiratory syncytial virus (RSV), the most common cause of acute bronchiolitis. Our aim was to evaluate the efficacy and safety of nebulized HS therapy for acute bronchiolitis due to RSV in moderately ill hospitalized infants. MATERIALS AND METHODS: This was an open-label, multicenter, randomized controlled trial comparing a nebulized HS treatment group with a normal saline (NS) group. The subjects, 128 infants with bronchiolitis due to RSV, were admitted to five hospitals in Tokyo, Japan. Three-percent HS or NS was administered via bronchodilator four times daily post-admission. The primary outcome was LOS, defined as the time until the patients fulfilled the discharge criteria, namely, absence of fever, no need for supplemental oxygen, and adequate feeding. Survival analysis was conducted in accordance with the intention-to-treat principle. RESULTS: The baseline characteristics were similar between the two groups. There was no significant overall difference in LOS between the groups (4.81 ± 2.14 days in HS vs 4.61 ± 2.18 days in NS; P = 0.60). Survival analysis by log-rank test also showed no significance (P = 0.62). Multivariate adjustment did not significantly alter the results. The treatment was well-tolerated, with no adverse effects attributable to the use of HS. CONCLUSIONS: Nebulized HS therapy did not significantly reduce LOS among infants with bronchiolitis due to RSV.

Unprecedented intraspecific diversity of the MHC class I region of a teleost medaka, Oryzias latipes.

The major histocompatibility complex (MHC) is present at a single chromosomal locus of all jawed vertebrate analyzed so far, from sharks to mammals, except for teleosts whose orthologs of the mammalian MHC-encoded genes are dispersed at several chromosomal loci. Even in teleosts, several class IA genes and those genes directly involved in class I antigen presentation preserve their linkage, defining the teleost MHC class I region. We determined the complete nucleotide sequence of the MHC class I region of the inbred HNI strain of medaka, Oryzias latipes (northern Japan population-derived), from four overlapping bacterial artificial chromosome (BAC) clones spanning 540,982 bp, and compared it with the published sequence of the corresponding region of the inbred Hd-rR strain of medaka (425,935 bp, southern Japan population-derived) as the first extensive study of intraspecies polymorphisms of the ectotherm MHC regions. A segment of about 100 kb in the middle of the compared sequences encompassing two class Ia genes and two immunoproteasome subunit genes, PSMB8 and PSMB10, was so divergent between these two inbred strains that a reliable sequence alignment could not be made. The rest of the compared region (about 320 kb) showed a fair correspondence, and an approximately 96% nucleotide identity was observed upon gap-free segmental alignment. These results indicate that the medaka MHC class I region contains an approximately 100-kb polymorphic core, which is most probably evolving adaptively by accumulation of point mutations and extensive genetic rearrangements such as insertions, deletions, and duplications.

Repetitive elements in the major histocompatibility complex (MHC) class I region of a teleost, medaka: identification of novel transposable elements.

The repetitive elements of medaka (Oryzias latipes) are poorly characterized in spite of recent rapid progress in the medaka genome analysis. Here we report the characterization of the repetitive elements in the major histocompatibility complex (MHC) class I region, which spans about 400 kb and is one of the best characterized regions of the medaka genome. Microsatellite, low complexity regions, transposable elements, and other repeats occupied 0.68, 0.98, 7.0 and 2.9%, respectively, of the MHC class I region. Eleven transposable elements, three LTR-type, six LINE-type and two DNA-type, including several novel ones, were identified. Genomic Southern hybridization analysis indicated that these LINE-type and DNA-type elements have many copies in the medaka genome, whereas the LTR-type elements have only several copies. The comparison of the medaka MHC class I region with those of zebrafish and fugu shows the presence of three medaka lineage-specific tandem duplications of the PSMB (proteasome beta-type subunit) 8 and class Ia genes. Since eight of the 11 transposable elements were located in this region, these elements may have played a role in the medaka-specific DNA rearrangement.

Thymic myoid cells as a myasthenogenic antigen and antigen-presenting cells.

We investigated immune property of a myoid cell line, established from Fisher rat thymus. Immunization of syngeneic rats with the myoid cells induced anti-rat acetylcholine receptor (AChR). Implantation of them into the thymus failed to induce typical thymic pathology of human myasthenia gravis (MG) or anti-AChR responses. We also demonstrated that the myoid cells were able to present exogenous antigens to T cells and induce antigen-specific T cell proliferation. These results suggest that myoid cells have the potential antigenicity to induce anti-AChR and the functions of antigen-presenting cells, but their expansion in the thymus may not directly cause MG.

Nucleotide sequence of the MHC class I genomic region of a teleost, the medaka (Oryzias latipes).

Teleost orthologs of the human major histocompatibility complex (MHC)-encoded genes show a dispersed distribution over several chromosomal loci. However, some of them, including the MHC class I alpha chain genes, are tightly linked to each other, forming the teleost MHC class I region. To elucidate the evolution of vertebrate MHC, we have determined the complete nucleotide sequences of two bacterial artificial chromosome (BAC) clones, encompassing the MHC class I region of the inbred Hd-rR strain of the medaka (Oryzias latipes). The 425862 bp nucleotide sequence predicted 20 possibly expressed genes and three pseudogenes. Except for one gene, CIZ, whose human ortholog is located at 12p13.31, all identified genes were orthologs or closely related relatives of the human MHC-encoded genes. Two classical class I alpha chain genes and the six other genes directly involved in class I antigen presentation formed an uninterrupted cluster. Comparison of the MHC class I region genes among three teleost species, the medaka, zebrafish and pufferfish, indicated that the content, but not the order or transcriptional orientation, of the genes is highly conserved. These results suggest that a strong selective pressure has conserved the linkage of certain MHC genes during vertebrate evolution, despite recurrent genetic rearrangements.

Adenocarcinoma of the renal pelvis with vimentin-positive intracytoplasmic inclusions.

A case of mucus-producing papillary adenocarcinoma of the renal pelvis associated with multiple renal calculi in a 16-year-old male is reported. The majority of the tumor cells contained large, round or cone-shaped, vimentin-positive intracytoplasmic inclusions, which exhibited some morphological and immunohistochemical resemblance to inclusions found in malignant rhabdoid tumor of the kidney. An intracytoplasmic accumulation of mucus was also noted in some tumor cells. The patient is free from recurrence and metastasis after a nephrectomy.

[Clinical evaluation of urinary basic fetoprotein and the BTA test for detection of bladder cancer].

We compared the results of urinary basic fetoprotein (BFP) and the BTA test with those of urinary cytology in patients with bladder cancer. We also analyzed the urinary BFP and the BTA test results in patients with benign diseases and postoperative bladder cancer with no evidence of recurrence. The cutoff value for urinary BFP was set at 10 ng/ml. Classes 4 and 5 according to urinary cytology were defined as positive. The sensitivity of urinary BFP for Ta, 1 bladder cancer was significantly higher than that of urinary cytology (p < 0.05). The urinary cytology positive rate for Ta, 1 bladder cancer improved when combined with urinary BFP and the BTA test. The urinary BFP positive rate for benign diseases was significantly higher in patients with pyuria than in patients without pyuria (p < 0.05). The BTA test positive rate for benign diseases was higher in patients with pyuria than in patients without pyuria. The urinary BFP and the BTA test positive rates for postoperative bladder cancer with no evidence of recurrence was significantly higher in patients with urinary diversion than in patients without urinary diversion (BFP: p < 0.01, BTA: p < 0.05).

[A case of retroperitoneal teratoma in an adult resembling adrenal tumors].

A retroperitoneal teratoma arising from the vicinity of the upper pole of the right kidney in a 61-year-old woman is described. Computed tomographic (CT) scan showed well marginated fat density mass with calcification. Magnetic resonance imaging (MRI) on T1 weighted image and T2 weighted image showed a high-intensity mass above the upper pole of the right kidney. Needle biopsy under computed tomography was performed, but no specimen was obtained. The preoperative diagnosis was retroperitoneal teratoma or right adrenal myelolipoma. The tumor was resected and the histological diagnosis was benign retroperitoneal cystic teratoma.

[Clinical results of transurethral electrovaporization of prostate (TVP) with two vaporization electrodes].

Transurethral electrovaporization of the prostate (TVP) is a new minimally invasive procedure for treatment of enlargement of prostate. Between April 1996 and September 1997, TVP was carried out in 109 cases with symptoms of lower urinary tract obstruction. A Stortz spike electrode and a Stortz vapor cutting electrode were used for vaporization electrodes. Efficacy parameters evaluated included International Prostate Symptom Score, peak uroflow and postvoid residual volume. By September 1997, 32 cases (spike electrode) and 33 cases (vapor cutting electrode) could be followed up and evaluated. They have shown both subjective and objective voiding improvement. The improvements in subjective symptom scores and objective voiding parameters were not significantly different between the two electrode groups. Early complications included urinary retention, intraoperative burn, stress incontinence, blood transfusion and postoperative hemorrhage. Late complications included urethral stricture, bladder neck contracture and bladder stone. TVP was found to have several advantages, particularly minimal bleeding and the low incidence of postoperative morbidity. The technique is simple and symptoms improve at an early stage following surgery. This study demonstrates that TVP is a safe and effective modality for treatment of BPH. However, long-term studies with larger numbers of patients are needed.

[Primary adenocarcinoma of the renal pelvis in a young male: a case report].

The patient was a 16-year-old male who visited our hospital with the chief complaint of microhematuria. Computed tomography revealed left hydronephrosis, renal stones and left renal tumor. Needle biopsy was performed under ultrasonography. The histological diagnosis was adenocarcinoma and left radical nephrectomy was performed. The histological diagnosis was mucinous adenocarcinoma of the renal pelvis. Postoperative chemotherapy was not given. The patient has had neither recurrence nor metastasis for 1 year following surgery. This is the 92nd reported case in the literature.

Chromophobe cell renal carcinoma.

Chromophobe cell renal carcinoma is a recently established subtype of renal cell carcinoma. Herein we report a case of chromophobe cell renal carcinoma in a 67-year-old male patient who occasionally underwent computed tomography. In a microscopic study with hematoxylin and eosin stain, clear eosinophilic cytoplasm, and a moderately atypical nucleus were observed. And it was stained positively by Hale's colloidal iron. Ultrastructurally, the cytoplasm was filled with numerous microvesicles. From these results, this tumor was pathologically diagnosed as chromophobe cell renal carcinoma.

Double eyelid procedure by removal of transconjunctival orbital fat and buried sutures combined with sling technique to avoid wounding the eyelid.

In the typical transconjunctival buried suture procedure for double eyelids, the adhesion between the skin and the pretarsal tissue or conjunctiva through the tarsal plate and the sling with the skin, the levator, and Muller's muscle are obtained by suturing. These are assisted by the stab wound or a needle through the eyelid skin, and the skin wound takes several days to heal. Also these suturing knots are buried under the skin on the tarsal plate, so that these will tend to appear on the skin surface later on. Removing the excess orbital fat that migrates to the area of fixation and jeopardizes the effect of the suturing technique is performed with skin incision and usually leaves a linear scar. The author devised a method that makes a double eyelid with two linear, wide sutures that lie between the levator and Muller's muscle and the immediately adjacent subdermal tissue of the skin by using one thread. It also reduces the excess orbital fat through the conjunctiva without wounding the skin and makes face washing or application of make-up possible immediately after the operation. Only one ligation is left at the lateral subconjunctiva to avoid its appearance on the skin surface to effect easy correction in case necessary. This method has evolved from previous method of transcutaneously burying sutures for the double eyelid, which was made wide by a linear suture by using one thread. Insufficient results were observed in eight of 280 cases.

[Clinical results of transurethral electrovaporization of prostate (TVP)].

Transurethral electrovaporization of prostate (TVP) is a new minimally invasive procedure to treat enlargement of prostate. From April 1996 to the end of October, TVP was carried out in 37 cases (mean age, 71.0) with symptoms of urethral obstruction. Standard transurethral resection equipment was utilized. This included a Stortz 26F resectoscope with a Conmed SABRE 2400 electrical current generator. A Stortz 3 mm Spike Electrode was used as the vaporization electrode. The average setting was 250 W for cutting and 80 to 100 W for coagulation. Efficacy parameters evaluated included International Prostate Symptom Score, peak uroflow and postvoid residual volume. By the end of January 1997, 28 cases could be followed up for more than three months after surgery and evaluated. Postvoid residual volume decreased from 68 to 10 and 17 ml at 1 and 3 months. Peak uroflow increased from 8.5 to 15.1 and 17.9 ml/sec at 1 and 3 months. All 28 cases were categorized as effectively treated cases at 1 and 3 months postoperatively. TVP was found to have several advantages, particularly minimal bleeding and the low incidence of postoperative morbidity. The technique is simple and symptoms improve at an early stage following surgery. We intend to continue longer follow up with larger numbers of patients.

[Prune belly syndrome with atresia ani and urethral stricture: a case report].

A case of prune belly syndrome associated with urethral stricture and atresia ani is reported. Cystostomy and colostomy were performed on his birthday. Cutaneous vesicostomy, bilateral ureterocystoneoplasty and proctoplasty were performed when the patient was one year old, and urethrotomy was performed when he was four years old. He was closely followed for six years and six months, and had developed without any serious episodes. We collected 128 cases of prune belly syndrome from the Japanese literature including this, and made a brief discussion of this syndrome with urethral stricture and atresia ani.

Correction of inverted nipple with periductal fibrous flaps.

I devised a method to correct the inverted nipple considering the preservation of the lactiferous ducts, sensory fibers to the nipple, and the contracting function of the areolar muscle. Excision of the excess skin at the base of the nipple was done in three diamonds fashion, and they were located at 2, 6, and 10 o'clock positions not to jeopardize the sensory fibers to the nipple. To release the fastened nipple, the periductal fibrous tissue was thoroughly dissected and made into three flaps pedicled inferiorly. These three flaps were sutured to the dermis of the periareolar skin to pull up the nipple base by means of traction in three directions. The purse-string suture, the dermal stitch on the shorter diagonals of the diamond-shaped defects, anchors the skin-muscle bridges caught at the base of the ductal column, makes the nipple base narrower, obtains stable anchoring, helps the areolar muscle contraction to resume, and prevents the recurrence of the inversion. The use of the periductal tissue as flaps to bring in areolar skin for easier anchoring and for more prominent eversion of the nipple has not been described in the literature.

Immediate breast reconstruction with subpectoral implantation after transaxillary subcutaneous mastectomy for siliconoma.

Immediate breast reconstruction on 14 patients suffering from breast hardening after augmentation mammaplasty by injection of silicone gel was performed. Transaxillary subcutaneous mastectomy was done followed by insertion of a double-lumen prosthesis into the subpectoralis plane. The result was greatly influenced by the amount of injected silicone gel. The patient was carefully observed after surgery, and the prosthesis was immediately removed when abnormal skin changes became apparent. Seven cases had no hardening on either side and 1 case had hardening on one side, 3 cases had hardening on both sides and 1 case on one side, 2 cases had the prosthesis removed from both sides and 2 cases from one side. All other cases with hardening or prosthesis removal, except one with removal from both sides, were subsequently reconstructed after more than three months.

Augmentation rhinoplasty with soft tissue and cartilage.

Augmentation rhinoplasty using soft tissue and cartilage was performed on 120 patients and the results were reexamined. They were found to be satisfactory and without complication. To narrow a round tip, a resection of two-thirds of the lateral crus cephalad portion and a transection of the caudal portion with a strip resection was done. To elevate the tip, septal cartilage was sutured to one-third of the upper part of medial crus to form a columella cartilage strut. To maintain the strut and to prevent pointing, a fibrous muscle tissue stretching from the medial crus to the upper cartilage or a dermis was transplanted into the area surrounding the septal cartilage tip. For a simple elevation of the dorsum, an onlay graft of dermis was applied, but where further elevation was required, further dermis and conchal cartilage was added for suture and attachment to the dermis.