Evaluation of compressed lung CT image quality using quantitative analysis

The goals of this study were (1) to evaluate the quality of compressed lung CT images obtained using high resolution CT (HRCT: 2 mm slice thickness) for degree of compression and conventional CT (10 mm slice thickness) images by using physical and subjective evaluations, and (2) to analyze the distortion of density distribution on lung CT images using histogram analysis for each compression ratio. The coding method was performed according to the Joint Photographic Experts Group (JPEG). We physically evaluated the quality of compressed lung CT images using the peak signal-to-noise ratio (PSNR) as given by the square root of the ratio of the peak value of the gray level squared to the mean square error (dB) and subjectively evaluated the CT images using the mean opinion score (MOS). The acceptable compression ratio for diagnosis was about 1:6 to 1:7 for conventional CT images and about 1:4 to 1:5 for HRCT images as determined by MOS. The PSNR corresponding to acceptable compression ratios was about 50 dB. The difference in density distribution between HRCT and conventional CT was statistically significant (Friedman test: p<0.02) in histogram analysis. Results suggested that, in comparison with conventional CT, a high compression ratio was not suitable for HRCT.

Limited proteolysis of filamin is catalyzed by caspase-3 in U937 and Jurkat cells

Members of the caspase family have been implicated as key mediators of apoptosis in mammalian cells. However, few of their substrates are known to have physiological significance in the apoptotic process. We focused our screening for caspase substrates on cytoskeletal proteins. We found that an actin binding protein, filamin, was cleaved from 280 kDa to 170, 150, and 120 kDa major N-terminal fragments, and 135, 120, and 110 kDa major C-terminal fragments when apoptosis was induced by etoposide in both the human monoblastic leukemia cell line U937, and the human T lymphoblastic cell line Jurkat. The cleavage of filamin was blocked by a cell permeable inhibitor of caspase-3-like protease, Ac-DEVD-cho, but not by an inhibitor of caspase-1-like protease, Ac-YVAD-cho. These results suggest that filamin is cleaved by a caspase-3-like protease. To examine whether caspase-3 cleaves filamin in vitro, we prepared a recombinant active form of caspase-3 directly using a Pichia pastoris overexpression system. When we applied recombinant active caspase-3 to the cell lysate of U937 and Jurkat cells, filamin was cleaved into the same fragments seen in apoptosis-induced cells in vivo. Platelet filamin was also cleaved directly from 280 kDa to 170, 150, and 120 kDa N-terminal fragments, and the cleavage pattern was the same as observed in apoptotic human cells in vivo. These results suggest that filamin is an in vivo substrate of caspase-3.

[Complement activity among individuals at a ground self-defense force base]

OBJECTIVE

This study aims to examine the distribution of hemolytic complement activity, the prevalence of hypocomplementemia and the disorders causing hypocomplementemia among individuals taking part in a mass screening program.

METHODS

The subjects consisted of 1340 male Japanese participating in a mass screening program at a Ground Self-Defense Force base in Asaka. We measured the hemolytic complement activity (CH50) after overnight fasting. The CH50 levels for hypercomplementemia and hypocomplementemia were defined as those outside the range of mean +/- 2 SD, respectively. We next measured the concentration of complement components: CIq, C4, B, C3, C5, C9, and C1-inhibitor for men with hypocomplementemia. Rheumatoid factor, ANA, HBsAg, HbsAb, and HCVAb were also measured.

RESULTS

The mean +/- SD of age was 43.7 +/- 5.7. The CH50 levels ranged from 7.2 to 66.4 U/ml (mean +/- SD = 37.1 +/- 4.0 U/ml). Twenty-one and 37 men were classified as having hypocomplementemia (CH50 < 29.1 U/ml) and hypercomplementemia (CH50 > 45.1 U/ml), respectively. The age of the individuals with hypocomplementemia was 43.9 +/- 5.6 (Mean +/- SD) years. Three men with C9 deficiencies, 2 men with C5 deficiencies and 7 men with cold activation were identified among the 21 hypocomplementemic men. Three hepatitis C and 2 hepatitis B patients were also found among the 21 hypocomplementemic men. Other disorders found among the hypocomplementemic men were 3 glomerulonephritides and 1 possible SLE.

CONCLUSION

We examined the distribution of CH50 levels in 1340 adult male Japanese. We identified 21 men with hypocomplementemia, and also found 5 cases of complement component deficiencies among 21 hypocomplementemic men. In addition the measurement of the complement activity may have also helped detect the presence of hepatitis, hypocomplementemic glomerulonephritis and collagen disease at an early stage.

Solitary fibrous tumor of renal pelvis

A 70-year-old Japanese man was referred because of a right renal mass of 2 years in duration. Imaging studies, including magnetic resonance imaging, revealed an ovoid mass, with relatively abundant vascularity, in the right renal pelvis. Right radical nephrectomy was done and a tumor measuring 6.0 x 4.5 x 4.0 cm was found in the renal pelvis. Solitary fibrous tumor (SFT) was highly suspected by histology. Immunohistochemical study using a monoclonal antibody directed against the human hematopoietic progenitor cell antigen (CD34) stain confirmed SFT. This is the first case of SFT of the renal pelvis. Although SFT is extremely rare in urogenital organs, this tumor must be included in the differential diagnosis when we encounter urogenital tumors consisting of mesenchymal elements.

Coffee consumption and serum aminotransferases in middle-aged Japanese men

We investigated the relation between coffee drinking and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations among 7313 Japanese men receiving a health examination, excluding former alcohol drinkers and men with a history of chronic liver disease. Serum AST > 40 and/or ALT > 40 U/L was defined as liver inflammation. Adjustment was made for alcohol use, smoking, body mass index, serum marker for hepatitis virus infection, and other possible confounders. Adjusted odds ratios of liver inflammation were 1.00 (reference), 0.80, 0.69, and 0.61 for men drinking < 1, 1-2, 3-4, and > or = 5 cups of coffee daily, respectively. Among 6898 men without liver inflammation, serum AST and ALT were inversely associated with coffee consumption, and alcohol-related rise in AST was attenuated with coffee drinking. These findings suggest coffee may have an effect of suppressing the rise of serum aminotransferase, partly by inhibiting the alcohol-related elevation. Studies regarding biological mechanism are warranted.

Visualizing synapse formation and remodeling: recent advances in real-time imaging of CNS synapses

The formation and maintenance of synaptic connections are critical in the development and plasticity of the central nervous system (CNS). Until recently, there have been few studies that followed the molecular sequences of the CNS synapse formation and maintenance. This situation changed dramatically after the introduction of green fluorescent protein (GFP)-based fluorescent probes and the development of lipophilic tracers of endocytotic membranes. These techniques enabled us to visualize presynaptic and postsynaptic structures in living neurons and illustrated active transport and remodeling of synaptic components. Furthermore, recent attempts to identify correlation between presynaptic and postsynaptic morphogenesis suggested very rapid time course of synapse formation at the individual axo-dendritic contact sites. These recent works clearly demonstrated the power of real-time imaging studies. Development of a wide variety of fluorescent probes and advances in the imaging techniques in future will further extend our knowledge on the molecular events that take place in the process of the development and maturation of synaptic junctions.

The effect of the weight reduction on the salivary cortisol levels of judo players

The purpose of this study was to investigate the effect of weight reduction prior to a competition on the salivary cortisol level for first-rate judo players. Subjects were divided into three groups by the weight reduction rate. On the day before the competition, the cortisol levels of the low- and high-weight reduction group showed a tendency to decrease and were significantly lower than that of the non-weight reduction group (p<0.05). However, with regard to the change in the stress indices, there was a difference between the high- and low-weight reduction groups. In the high-weight reduction group alone, there was a significant increase in the stress indices on the day before the competition (p<0.05). These findings suggest that the HPA axis is affected during the relatively early stage of weight reduction and mental stress is increased at the higher weight reduction rate.

Effect of sodium butyrate on reactive oxygen species generation by human neutrophils

BACKGROUND

Short-chain fatty acids enema has been shown to be effective in the treatment of ulcerative colitis (UC). However, the mechanisms that lead to this response have not been well characterized. The aims of this study were to investigate the effect sodium butyrate has on reactive oxygen species (ROS) generation by human neutrophils, which are responsible for mucosal injury.

METHODS

Human neutrophils incubated with or without sodium butyrate were stimulated with opsonized zymosan (OZ) or phorbol myristate acetate (PMA). ROS generation was largely differentiated with flow cytometry assays of hydroethidine oxidation and dichlorofluorescein oxidation for superoxide anion and hydrogen peroxide respectively, and luminol-dependent chemiluminescence for myeloperoxidase-mediated oxidants.

RESULTS

Sodium butyrate (up to 50 mM) did not alter hydroethidine oxidation upon stimulation of the OZ or PMA. However, sodium butyrate at a concentration of 25 mM elevated dichlorofluorescein oxidation to 125 + 8% (P = 0.028) of control upon stimulation of OZ and to 191 +/- 30% (P = 0.0016) upon stimulation of PMA. Contrary to these results, sodium butyrate greatly inhibited chemiluminescence responses in a dose-dependent manner. The inhibition by 50 mM sodium butyrate was 61 +/- 6% upon OZ and 71 +/- 9% upon PMA, respectively.

CONCLUSIONS

These data indicate that sodium butyrate up-regulates hydrogen peroxide generation but down-regulates generation of myeloperoxidase-mediated oxidants, the latter being more potent in killing microorganisms and in inducing tissue injury. A possible mechanism is suggested whereby sodium butyrate may inhibit myeloperoxidase activity and hence attenuate the destructive activities of neutrophils in UC.

Proximal-type epithelioid sarcoma: a clinicopathologic study of 20 cases

We studied the clinicopathologic and immunohistochemical features of 20 cases of proximal-type epithelioid sarcoma to identify prognostic factors. The 20 patients ranged in age from 13 to 80 years (mean, 40 y); 12 patients were male and 8 were female. The tumors presented as deep soft-tissue or subcutaneous masses on the inguinal region in five, the thigh in four, the vulva in three, the axilla in three, and one each in the flank, chest wall, back, hip and perineum. The tumors ranged from 2 to 16 cm at their greatest diameter (mean: 7.8 cm). Histologically, 12 tumors (60%) were classified as the large-cell subtype, characterized by sheets of large cells with prominent nucleoli resembling poorly differentiated carcinoma, and a frequent rhabdoid phenotype, six (30%) were classified as the conventional subtype, and two (10%) as the angiomatoid subtype. The numbers of tumors exhibiting immunoreactivity for various markers were: vimentin (20 cytokeratin (20 [100%]); epithelial membrane antigen (17 [85%]); CD34 (9 [45%]); CD99 (5 [25%]); muscle markers, either desmin or alpha-smooth muscle actin (3 [15%]), other markers such as S-100 protein, neurofilament, neuron-specific enolase, synaptophysin and CD56 (12 [60%]); and p53 (16 [80%]). Fourteen lesions (70%) exhibited an MIB-1 index of 30% or more and, by a system of histologic grading using the MIB-1 score, 16 tumors (80%) were classified as high-grade (Grade 3). Thirteen patients (65%) developed local recurrence and 15 (75%) had metastases, primarily to the lymph nodes. At the last follow-up, 13 patients (65%) had died of their disease. A large tumor size and early metastasis were independently associated with a poor outcome. We conclude that proximal-type epithelioid sarcomas are rare, undifferentiated soft-tissue sarcomas of adults, with epithelioid features and a frequent rhabdoid phenotype. These tumors, when arising in proximal locations, have a much worse prognosis than those arising in distal locations.

Clinical study of testicular germ cell tumors

A clinical statistical analysis on 65 patients with 68 testicular germ cell tumors was performed. Thirty-six testes (53.7%) had seminomas and the remainder non-seminomatous germ cell testicular tumors (NSGCTTs). Of the seminomas, 31 (88.6%) were in stage I and the others showed distant metastases at presentation. Of the 32 NSGCTTs, 22 (68.8%) were in stage I. The average ages of the patients with seminomas and NSGCTTs were 40.4 and 29.9 years, respectively. Thirty-nine patients (60.0%) had tumors on the right side, 23 (35.4%) on the left and 3 (4.6%) in both testes. Five patients had a past history of cryptorchidism. Chief complaints in 49 patients (73.1%) were a painless scrotal mass. The interval from clinical onset to presentation was longer in seminoma patients than in NSGCTT patients (10.9 months on average versus 3.4 months). Immunosuppressive acidic protein (IAP) was a useful diagnostic tumor marker as well as alpha-feto protein (AFP), beta-human chorionic gonadotropin (beta-hCG) and lactic dehydrogenase (LDH). We adopted a surveillance policy in more than half of the stage I patients and obtained acceptable results. In the remaining cases, therapies including combination chemotherapy, radiation and salvage operation were performed after orchiectomy. The three-year survival rate was 98.0, 100.0 and 26.7%, for stage I, II and III patients respectively.

A multidisciplinary approach to the treatment of malignant pelvic bone tumors: results with eight consecutive patients

The prognosis for malignant pelvic bone tumors is worse than that for malignant bone tumors of the extremities because definitive surgery in the pelvis is often difficult to accomplish. The results for eight patients who were treated consecutively with a multidisciplinary approach, from 1990, were analyzed. The histologic diagnosis was osteosarcoma in five patients, chondrosarcoma in two, and Ewing's sarcoma in one. Five lesions arose in the ilium and three in the pubis. The extraosseous tumors decreased in size and/or were encapsulated as a result of preoperative chemotherapy in six patients, four of these achieving a wide surgical margin. With respect to tumor location and surgical margin, all five lesions in the ilium involved the sacrum, four of these being resected with an inadequate margin. The three lesions in the pubis were resected with an adequate margin. Local recurrence was observed in two patients who had been treated with an inappropriate margin. During the period between 18 and 57 months after the first operation, five patients were continuously free of disease and one was still alive but had lung metastases. Our results indicate that a patient's chances of definitive surgery may be enhanced by a multidisciplinary approach, although the management of sacroiliac involvement remains challenging.

Exercise training and energy restriction decrease neutrophil phagocytic activity in judoists

PURPOSE

To investigate the effects of weight reduction as the result of exercise training and energy restriction on neutrophil function.

METHODS

Eighteen male competitive college judoists participated in the study. In a whole blood assay, oxidative burst activity, phagocytic activity, expressions of Fc gamma receptor 3 (CD16), and complement receptor 3 (CD11b) of neutrophils were measured on a per cell basis by flow cytometry at day 20, 5, and 1 before and at day 7 after the competition.

RESULTS

The rate of neutrophil producing reactive oxygen species decreased before the competition, whereas the oxidative burst activity per cell increased significantly in all subjects, which resulted in a significant increase of the total oxidative burst activity. However, there were no significant effect of energy restriction on oxidative burst activity. The rate of neutrophils incorporating opsonized zymosan decreased significantly with energy restriction. The total phagocytic activity of 10,000 neutrophils and the phagocytic activity per cell also decreased significantly by severe energy restriction. The surface antigen expressions of CD11b and CD16 were unaffected by weight reduction.

CONCLUSIONS

The results suggest that with respect to the management of health conditions, weight reduction for judoists should be composed of exercise training and energy restriction should be moderate.

[Characteristics of heterosexually acquired AIDS in Japan. An inter-country comparison using AIDS Surveillance data]

OBJECTIVES

To identify epidemiological characteristics of heterosexually acquired AIDS in Japan, with emphasis on potential influence on future trends.

METHODS

National AIDS Surveillance data in Japan were compared with those in the UK and US, where detailed information is available from well-established surveillance procedures. Data on AIDS cases diagnosed until the end of 1996, particularly those acquired heterosexually, were analyzed by year of diagnosis, gender and age group.

RESULTS

The number of heterosexually acquired AIDS cases in Japan has continued to increase, while those in the UK and US leveled out or decreased recently. The increase during a two-year period after reaching a certain number of cases per year was found to be 2.3-fold in Japanese, 2.4-fold in UK whites and 5-fold in US whites. The male to female ratio (M/F) for heterosexually acquired AIDS was 6.3 among Japanese, while the ratio was 1.1 and 0.5 in the UK and US, respectively. The age distribution at AIDS diagnosis demonstrated a peak from 35 to 54 years of age among Japanese males, as compared to 30 to 34 among males in the UK and the US. No significant difference was apparent in the age distribution among females in the three countries.

CONCLUSIONS

The relatively small number of AIDS cases in Japan is attributable to the late introduction of HIV and the limited chance of heterosexual transmission from homosexual/bisexual men and injecting drug users. In addition, transmission has probably most often occurred between middle-aged Japanese males and non-Japanese females. As there is a growing risk of HIV infection among Japanese females and young Japanese males, new prevention strategies targeting these groups are urgently required.

Electron spin resonance observation of the Si(111)-(7x7) surface and its oxidation process

Electron spin resonance (ESR) observation of dangling-bond states on the Si(111)-(7x7) surface is demonstrated for the first time. The ESR spectra clearly show that a reaction of molecular oxygen with the Si(111)-(7x7) surface is associated with the appearance of a new dangling-bond center at unreacted Si adatoms. Most of the oxidized surface sites do not show ESR signals, but in a minor part of the surface another new type of surface defect is detected. The well known P(b) center at the SiO2/Si interface is found to evolve at an oxide thickness as thin as 0.3 nm.

Effect of interferon-alpha on production of reactive oxygen species by human neutrophils

In order to examine that the effects of interferon alpha (IFN-alpha) on the production of reactive oxygen species from human neutrophils, we investigated in vitro effects of IFN-alpha on neutrophil chemiluminescence responses. Human neutrophils were incubated with 0-1 x 10(5) IU/mL IFN-alpha for 10-60 min just before stimulation with opsonized zymosan and phorbol 12-myristate 13-acetate. Luminol-dependent (LmCL) and lucigenin-dependent (LgCL) chemiluminescence responses were measured using a Lumi Box H-1000. The LmCL response was inhibited by pre-incubation with high concentrations of IFN-alpha (more than 1 x 10(4) IU/mL). In contrast, LgCL response was increased when neutrophils were pre-incubated with high concentration of IFN-alpha. Effects of pre-incubation of IFN-alpha were similar between CL responses stimulated with OZ and PMA. The increase of LgCL might be due to the inhibitory effect of IFN-alpha on myeloperoxidase degranulation, in view of the decreased LmCL responses.

Determination of a new oral cephalosporin, cefmatilen hydrochloride hydrate, and its seven metabolites in human and animal plasma and urine by coupled systems of ion-exchange and reversed-phase high-performance liquid chromatography

Multidimensional HPLC systems with coupled anion-exchange, cation-exchange, and reversed-phase columns, and ultraviolet and electrochemical detectors were developed for the determination of cefmatilen and its seven metabolites in the plasma and urine of humans and animals. These target compounds with a wide range of polarities were efficiently separated and determined by HPLC assay methods with simple pretreatments, deproteinization of plasma and dilution of urine. The assay methods showed good linearity, precision and accuracy. The methods were successfully applied to pharmacokinetic and metabolic studies of cefmatilen hydrochloride hydrate administered orally to humans and animals.

Pericentric inversion of the Y chromosome of infertile male

The authors report a case with pericentric inversion of the Y chromosome associated with asthenonecrozoospermia. The conventional karyotype was 46, X, inv (Y) (p11q11). Polymerase chain reaction (PCR) analysis revealed the deletion of DYZ3, DYS139, and RBM1. Three-color fluorescent in situ hybridization (FISH) analysis of the sperm chromosomes showed normal ratio between X- and Y-bearing sperm. In this case, the frequencies of aneuploidy of the sperm are not significantly higher compared with those from the normal volunteers. Cytogenetic analysis is recommended when the patients with pericentric inversion of the Y chromosome are attending an infertility clinic.

Immunohistological distribution of stem cell factor and kit receptor in angiosarcoma

Angiosarcoma is a rare neoplasm, originating in the endothelium, which has a poor prognosis because of a high potential for metastasis. Although little is known about the pathogenesis of angiosarcoma, angiogenic cytokines are suggested to play an important role in tumor progression in a paracrine/autocrine fashion. Mast cells contain several mediators or cytokines influencing vascularization. To clarify the role of mast cells in angiosarcoma, mast cells were counted in primary lesions of angiosarcoma (n=7). The results showed that the number of mast cells in the lesional skin of angiosarcoma (91.2+/-14.6/mm2) was significantly increased compared to that in normal skin (30.1+/-4.6/mm2) (p < 0.001). Immunohistological localization of stem cell factor, a mast cell growth factor, demonstrated that stem cell factor-positive cells occurred in the tumors forming the vascular lumen in nodular-type angiosarcoma. In macular angiosarcoma, stem cell factor was also detected in the tumor vascular endothelial cells. Infiltrating mast cells were positive for the kit receptor in both types of angiosarcoma. These results suggest that tumor cell-derived stem cell factor may play a role in the increased number of mast cells, via the kit receptor, which may contribute to the proliferation of tumor cells, leading to the progression of angiosarcoma.

A compression and transmission system of ultrasonic image sequence for telemedicine

OBJECTIVE

A newly developed compression and transmission system of ultrasound image sequence for telemedicine is proposed for transmitting ultrasonic image sequence in real time via IP-connected computers for telemedicine.

MATERIALS AND METHODS

In the compression method, the characteristics of ultrasound images were taken into account. Only sound data were essential, and the histogram of the images had two narrow distributions around black-and-white areas. The sound data, therefore, were run length encoded and then transmitted. In the transmission, UDP/IP was employed with a time weight insertion among the packets so as not to overflow the data buffers of computers in this system to derive the maximum transmission performance up to the network capacity. The decompression method was the same as the generation of the sector scan images from the sound data, so that natural ultrasound image sequence could be obtained.

RESULTS

This system was evaluated by transmitting the ultrasonic image sequence of the heart via ISDN (1. 5 mbps). Although this system completely specialized in compression and transmission of the ultrasound sector scan image sequence, a relatively good performance in the frame rate and the image quality was achieved, compared with the previous systems (H.260, JPEG, and MPEG-1).

Toxic shock syndrome after suction lipectomy

We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.

Reciprocal changes in leptin and tumor necrosis factor-alpha with exercise in insulin resistant rats

Leptin and tumor necrosis factor--alpha(TNF-alpha) are important mediators of insulin resistance in obese subjects through their over-expression in adipose tissue. Secretion of leptin into the circulation is a signal for the brain in patients with hyperinsulinemia. Regulation of TNF-alpha affects adipocyte insulin sensitivity and lipid accumulation. Exercise training has been suggested for the prevention and treatment of such disorders. However, how exercise modifies secretion of leptin and TNF-alpha is not known. We investigated leptin and TNF-alpha in a rat model of insulin resistance induced by sucrose. After 4 weeks of sucrose feeding, 4 weeks of voluntary wheel running significantly reduced the concentrations of leptin in mesenteric (MS) and subcutaneous fat (SC) when compared to sedentary sucrose-feeding rats. These results suggest that exercise controls cytokine regulation of leptin and TNF-alpha. The increased TNF-alpha in adipose tissue may activate cytolysis for energy consumption.

beta-catenin mutations are absent in hepatocellular carcinomas of SV40 T-antigen transgenic mice

beta-catenin mutations have been found not only in melanoma and prostatic carcinoma but also in hepatocellular carcinomas in human, c-myc, H-ras genes transgenic mice and chemically-induced models. We investigated beta-catenin mutations in human hepatocellular carcinomas (HCCs), Hep G2 cell line and HCCs in SV40 T-antigen transgenic mice, in order to examine whether beta-catenin mutations are frequently observed in HCC in general. We found a point mutation of beta-catenin in one of nine HCCs in human and a deletion of it in Hep G2 cell line. However, we found no mutation in HCC in SV40 TG mice liver.

Reconstruction of congenital microtia by using a tissue expander

In the conventional reconstruction of microtia, skin grafting is an absolute necessity because of the scantiness of the skin tissue at the affected site. As the result, color- and texture- matching as well as sensory preservation remain to be improved. To solve these problems, we developed a surgical procedure for reconstruction of microtia by using a tissue expander, which allowed us to reconstruct the erect auricle without the need for skin grafting. In this paper, we introduce and discuss our method using the tissue expander with a review of the literature. We operated on a total of 38 patients with microtia. Most of the patients were around 10 years of age, but 3 were adults. Autogenous cartilage was used, and the helix, antihelix, concha, and tragus were reproduced. Initially, 70 ml custom-made expanders were used; after that, 75 ml or 95 ml ready-made expanders were used. The erect auricle was reconstructed by the primary procedure in 33 patients. The reconstructed auricle was satisfactory in color- and texture-matching and had nearly normal sensation. No major absorption of the cartilage has been noted for 15 years, although a slight retraction of the expanded skin was observed in each patient. In conclusion, microtia repair by using a tissue expander is superior to that by conventional procedures in color- and texture- matching and sensory preservation of the reconstructed auricle.

Bilateral emphysematous pyelonephritis with autosomal-dominant polycystic kidney disease successfully treated by conservative method

Emphysematous pyelonephritis (EPN) is an uncommon and potentially life-threatening necrotizing inflammation of the renal parenchyma. EPN associated with autosomal dominant polycystic kidney disease (ADPCK) is extremely rare. We report such a case of bilateral EPN with ADPCK that was successfully treated with conservative methods. To our knowledge, our case is only the second to document bilateral EPN occurring with ADPCK and the first one to be treated successfully with conservative methods.