A case of Epstein-Barr virus-associated pulmonary leiomyosarcoma arising five yr after a pediatric renal transplant.

EBV-associated SMTs in immuno-compromised patients have recently been reported. We report on a case of EBV-associated pulmonary leiomyosarcoma arising five yr after renal transplantation. The patient was an eight-yr-old girl, who received a living related kidney transplant from her mother. She had had bilateral giant Wilm's tumors as an infant and underwent bilateral nephrectomy at one and two yr of age. At the age of seven, she suffered from bronchitis several times, and a year later, two nodules were detected in her left lung by X-ray and computed tomography. We suspected a recurrence of Wilm's tumor and performed surgical resection. The pathological finding was SMT with moderate mitosis and no evidence of Wilm's tumor. The fact that the tumors were positive for EBER suggested an association with the EBV. Six months later, there was a recurrence in her left lung. Surgical resection was performed, and immunosuppressive agents were reduced. Two yr after the second operation, she is well with no recurrence. We report the first case of EBV-associated pulmonary leiomyosarcoma in a pediatric patient after renal transplantation owing to a malignant tumor.

Ortho-phthalaldehyde-induced skin mucous membrane damage from inadequate washing.

Because body fluids and blood have a tendency to adhere to transesophageal echo devices, a high level of sterilisation is required when cleaning them. Ortho-phthalaldehyde (OPA) has been widely used in Japan since being approved as a high-level sterilant. The authors report a patient with widespread, severe skin and mucous membrane damage of the lip, tongue, pharynx and oesophagus areas that was attributed to inadequate washing after the sterilisation of a transesophageal echo device with OPA. This patient experienced sequelae, which did not improve after more than 1 year of continuous treatment. When using medical devices sterilised with OPA, the use of a probe cover, when applicable, is recommended and complete washing prior to use is required.

Recurrent pancreatitis caused by pancreatobiliary anomalies in children with annular pancreas.

PURPOSE: Annular pancreas (AP) is usually associated with duodenal obstruction in neonates. Pancreatitis with AP occurs frequently in adults but is rare in children. This article describes pancreatitis in children with AP and pancreatobiliary anomalies and its surgical treatment. PATIENTS AND METHODS: Six children who underwent duodenal bypass for AP subsequently developed recurrent pancreatitis. Three had trisomy 21. Duodenoduodenostomy had been performed in 5 patients and gastrojejunostomy in 1 patient for neonatal duodenal obstruction. We reviewed overall management, imaging, and surgical treatment in these children. RESULTS: All children subsequently complained of recurrent abdominal pain. Pancreatitis developed in 6 children, and magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed associated pancreatobiliary anomalies such as pancreas divisum, pancreatobiliary malunion, choledochocele, and intraluminal duodenal diverticulum. In 5 cases, surgery for recurrent or chronic pancreatitis was performed. The range of follow-up was 11 to 54 months, and all children who underwent surgery had excellent results. CONCLUSIONS: Children with AP occasionally require reoperation for recurrent pancreatitis because of associate pancreatobiliary anomalies. Magnetic resonance cholangiopancreatography and ERCP provide excellent images of pancreatobiliary anomalies. Intraoperative cholangiopancreatography is also essential for accurate depiction of the ductal structure and selection of the appropriate surgical procedure.

First-order phase transition of fixed connectivity surfaces.

We report numerical evidence of the discontinuous transition of a tethered membrane model which is defined within a framework of the membrane elasticity of Helfrich. Two kinds of phantom tethered membrane models are studied via the canonical Monte Carlo simulation on triangulated fixed connectivity surfaces of spherical topology. One surface model is defined by the Gaussian term and the bending energy term, and the other, which is tensionless, is defined by the bending energy term and a hard wall potential. The bending energy is defined by using the normal vector at each vertex. Both models undergo the first-order phase transition characterized by a gap of the bending energy. The phase structure of the models depends on the choice of discrete bending energy.

Monte Carlo simulations of branched polymer surfaces without bending elasticity.

We study a model of elastic surfaces that was first constructed by Baillie et al. for an interpolation between the models of fluid and crystalline membranes. The Hamiltonian of the model is a linear combination of the Gaussian energy and a squared scalar curvature energy. These energy terms are discretized on dynamically triangulated surfaces that are allowed to self-intersect. We confirm that the model has not only crumpled phases but also a branched polymer phase, and find that the model undergoes a first-order phase transition between the branched polymer phase and one of the crumpled phases. We find also that the model undergoes a second- (or higher-) order phase transition between the branched polymer phase and another crumpled phase.