Angioimmunoblastic T-cell Lymphoma Associated with IgA Nephropathy.

Few cases of IgA nephropathy with angioimmunoblastic T-cell lymphoma (AITL) have been reported. We herein present the case of a 79-year-old Japanese man with AITL and IgA nephropathy. The patient presented with generalized edema, fatigue, and fever. Laboratory investigations revealed polyclonal gammopathy with a high level of IgA, microscopic hematuria, proteinuria, and some other immunological abnormalities. Computed tomography revealed generalized lymphadenopathy. A diagnosis of AITL and IgA nephropathy was made based on inguinal lymph node and renal biopsies. Following chemotherapy for AITL, the patient's edema, microscopic hematuria, and proteinuria were alleviated. These findings indicate that IgA nephropathy may occur in AITL patients.

[Successful endovascular repair of a ruptured thoracoabdominal aortic aneurysm with severe mural thrombus].

A 51-year-old man was transferred to our hospital on an emergency basis complaining of a sudden onset of severe left lumbar back pain. An emergency contrasted computed tomography showed a ruptured thoracoabdominal aortic aneurysm( rTAAA:Crawford classification type III). The ruptured site was near the aortic bifurcation, and the aneurysm had a relatively narrow segment with an extensive mural thrombus just below the renal arteries. Considering the high mortality of open surgery for the rTAAA and the poor general condition of the patient, we decided to perform endovascular aneurysm repair (EVAR) as a rescue procedure using the narrowed segment by the thrombus for a proximal landing zone. The abdominal part of the thoracoabdominal aortic aneurysm (TAAA) was successfully excluded with a stent graft to obtain complete hemostasis. The postoperative course was uneventful except for the need for hemodialysis. Even though there is a risk of developing late type 1 endoleak, this procedure can be a feasible option as a rescue procedure or a bridge to radical open surgery for ruptured TAAA in a specially anatomical setting like this case.

Transmitral resection of a left ventricular apical papillary fibroelastoma using video-assisted thoracoscopy.

Papillary fibroelastomas (PFEs) are rare benign tumors usually found on cardiac valves, and do not commonly originate from the left ventricle (LV). We report a 74-year-old female with a PFE in the LV apex. We performed complete resection of the tumor through a transmitral approach using video-assisted thoracoscopy.

Successful hybrid treatment for a ruptured thoracoabdominal aortic aneurysm in a patient with systemic lupus erythematosus.

A 49-year-old woman with a 27-year history of systemic lupus erythematosus (SLE) was admitted to our hospital with sudden-onset severe back pain. An emergency multidetector computed tomography (MDCT) revealed a ruptured thoracoabdominal aortic aneurysm (TAAA) 80 mm in diameter. Considering her condition and comorbidities, we performed an emergency hybrid treatment: visceral reconstruction followed by endoluminal aneurysm exclusion. She recovered uneventfully, except for the need for temporary hemodialysis. TAAA complicated with SLE is extremely rare. To our knowledge, this is the first successful report in the English literature of a ruptured TAAA in a patient with SLE who underwent hybrid treatment.

A histological investigation of the maturation of the acorn worm, an inhabitant of the Sea of Japan, and a suggestion about the relationship between synchronized spawning/spermiation and the tidal level.

One species of Hemichordata, Balanoglossus misakiensis, is then acorn worm originally reported from the intertidal zone of the Miura Peninsula on the Pacific Ocean side of Japan. We histologically examined the reproductive cycle of the population of this species, which inhabits only the sublittoral zone in the Sea of Japan. Testes and ovaries began to develop at the beginning of May 2003 and were almost mature in the latter half of June in males and in the first half of July in females in the same year. Subsequently, spermiation and spawning followed in the latter half of July in males and in the first half of August in females. Progress in maturation appeared to be related to increases in the water temperature. Although some experiments were conducted in aquariums to identify the conditions responsible for the synchronization of the occurrence of spontaneous spawning/spermiation, no clues were obtained. During the experiments, however, 11, 2, and 4 individuals out of the 67 used achieved spawning/spermiation on separate days. The occurrence of spawning/spermiation in the laboratory corresponded to the latter half of the switch from high tide to low tide on those days. Also in the field, it was known that they released the gametes according to this specific schedule. Therefore, it was suggested that, in the Japan Sea population of this species, the tide level may be a condition for synchronized spawning/spermiation.

Advantages of off-pump coronary artery bypass grafting in long-term hemodialysis patients: multicenter analysis.

OBJECTIVE: Long-term hemodialysis remains a major risk factor for coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) is expected to offer benefits for these high risk patients; however, this issue has not been clarified. To elucidate the issue, we conducted a multicenter retrospective review of long-term hemodialysis patients who underwent on- or off-pump CABG. PATIENTS: Between January 1998 and December 2002, 53 hemodialysis patients underwent elective CABG at 14 centers. Nineteen patients underwent OPCAB, and 34 patients underwent conventional CABG (CCAB). Preoperative and perioperative variables, morbidity, and mortality were compared in the 2 groups. There were no significant differences in preoperative variables between the 2 groups. RESULTS: The length of intensive care unit (ICU) stay (3.7 versus 5.9 days), the amount of blood loss (668 versus 1100 mL), and the amount of red cell transfusion (4.7 versus 12.2 units) were less in the OPCAB group. The perioperative morbidity was significantly lower in the OPCAB group (0.0% versus 26.5%). The hospital mortality was not significant but was low in the OPCAB group (0% versus 14.7%, P = .079). CONCLUSION: OPCAB significantly decreased blood loss, blood transfusion, ICU stay, and major perioperative morbidity compared with the values for CCAB. OPCAB may have advantages over CCAB in long-term hemodialysis patients.

Effects of A23187 and CaCl(2) on tri-n-butyltin-induced cell death in rat thymocytes.

As tri-n-butyltin (TBT), one of the environmental pollutants, is accumulated in wild animals, concern regarding the toxicity of TBT in both wildlife and human is increasing. TBT has been reported to increase intracellular Ca(2+) concentration in several types of cells. In order to examine how Ca(2+) is involved in TBT-induced cell death, the effect of TBT on rat thymocytes has been compared with that of A23187, a calcium ionophore, under various concentrations of external Ca(2+) using a flow cytometer and fluorescent probes. Although both TBT and A23187 were toxic to cells under normal Ca(2+) condition, under external Ca(2+)-free condition the cytotoxic action of TBT was potentiated without changing the threshold concentration while that of A23187 was completely abolished. A23187 attenuated the TBT-induced descent in cell viability under normal Ca(2+) concentration despite intracellular Ca(2+) concentration was increased. As external Ca(2+) concentration increased, the TBT-induced increase in number of dead cells gradually decreased whereas the number of cells in an early stage of apoptosis increased. Results suggest that Ca(2+) has contradictory actions on the process of TBT-induced cell death in rat thymocytes.