Primary Cytomegalovirus Pneumonia Successfully Treated with Corticosteroid Therapy and Valganciclovir

Cytomegalovirus infection is typically asymptomatic in immunocompetent individuals. A 26-year-old woman was admitted to our hospital with a fever and breathlessness. Chest computed tomography (CT) revealed bilateral diffuse reticulation and nodules. Laboratory investigations showed atypical lymphocytosis and increased transaminases. She was treated with corticosteroid pulse therapy because of acute lung injury, and her clinical condition improved. Based on the presence of cytomegalovirus antibodies, antigen, and polymerase chain reaction findings, she was diagnosed with primary cytomegalovirus pneumonia and treated with valganciclovir. Primary cytomegalovirus pneumonia is very rare in immunocompetent individuals. The efficacy of corticosteroid and valganciclovir against cytomegalovirus pneumonia in this patient is noteworthy.

Fixation rate of fiducial gold markers in each segmental bronchus for stereotactic body radiotherapy

BACKGROUND

In real-time tumor-tracking radiotherapy for lung tumors, placement of fiducials, such as a gold marker (GM), is necessary. However, transbronchially placed GMs often drop out spontaneously. Therefore, we aimed to clarify the fixation rate of GMs in each segmental bronchus.

METHODS

In this study, we examined the fixation rates of 791 GMs placed in 235 patients (259 procedures), from November 2011 to November 2020, at a single facility. The relationship between the elapsed time and the fixation rate was assessed using the Kaplan-Meier method. Moreover, we measured the distance between the GM and the chest wall (DMC), as confirmed using planning computed tomography, and analyzed the relationship of this distance with the fixation rate.

RESULTS

Overall, 28.8% of GMs dropped out within 10 days of placement. The fixation rate of GMs in the bronchi was significantly lower in the upper lobe than in the other lobes, in both lungs (right, p < 0.01; left, p = 0.05). Moreover, in the left upper lobe, the fixation rate of GMs was significantly lower in B¹⁺² than in B³ (p = 0.0181). In addition, the group with a short DMC had a significantly higher GM fixation rate. (p < 0.01).

CONCLUSIONS

The fixation rate of GMs was lower in the upper lobes than in the lower lobes. Additionally, the fixation rate was lower in B¹⁺² than in B³. Shorter DMCs were associated with higher GM fixation rates.

Idiopathic Pulmonary Hemosiderosis Associated with Emphysematous Change in an Adult Who Underwent Lung Transplantation

Idiopathic pulmonary hemosiderosis is characterized by repeated alveolar hemorrhaging. We herein report a 52-year-old Japanese woman who had shortness of breath, diffuse small nodules, thin-walled cysts, and bronchiolectasis. A surgical lung biopsy revealed peribronchial hemosiderosis, centrilobular emphysema, and fragile elastic fibers of the alveolar septa and small vessels. She ultimately underwent living-donor lung transplantation five years after the first visit.

Impacts of pulsatile systemic circulation on endothelium-derived nitric oxide release in anesthetized dogs

BACKGROUND

The effects of pulsatile flow on endothelium-derived nitric oxide-mediated vasodilation are not fully elucidated in an in vivo model.

METHODS

A left ventricular assist device was established in 10 anesthetized dogs with a centrifugal pump and an air-driven pneumatic pump. The systemic circulation was subjected to step changes in the frequency of pulse (0, 30, 60, and 120 bpm with a fixed pulse pressure of 50 mm Hg), and in the amplitude of pulse (0, 20, and 50 mm Hg with a fixed pulse rate of 120 bpm). Hemodynamic variables and calculated total systemic vascular resistance were compared before and after the administration of N(G)-Nitro-L-arginine Methyl Ester (L-NAME) (20 mg/kg). Plasma NO2-/NO3- concentration levels were also measured.

RESULTS

Total systemic vascular resistance significantly decreased while plasma NO2-/No3- concentration increased in response to the rise in both pulse rate and pulse pressure. However, L-NAME significantly diminished these effects of pulsatile flow.

CONCLUSIONS

Both the frequency and the amplitude of pulse wave in the systemic circulation are significant independent stimuli for endothelium-derived nitric oxide-mediated vasodilation in vivo.

Coronary artery bypass grafting on the beating heart evaluated with integrated backscatter

BACKGROUND

In beating heart coronary artery bypass grafting (CABG) the effect of ischemic insult during coronary occlusion could not be evaluated immediately. Using transesophageal echocardiography, myocardial performance can be evaluated with analysis of integrated backscatter.

METHODS

In 15 beating heart CABGs, cyclic variation (CV) of integrated backscatter of the anterior wall before, during, and after the left internal thoracic artery to left anterior descending (LAD) branch anastomosis was measured with transesophageal echocardiography. The patients were divided into two groups according to collateral vessels status (good collateral group n = 6, poor collateral group n = 9).

RESULTS

In all patients, CV increased significantly after revascularization (8.56+/-2.50 to 11.47+/-3.32 dB, p < 0.0001). During LAD occlusion, significant decrease in CV was found in patients who had poor collateral arteries. At 15 minutes of LAD occlusion, CV decreased from the preocclusion value of 7.51+/-2.21 to 3.23+/-4.03 dB (p < 0.01).

CONCLUSIONS

Measurement of CV can detect the ischemic insult during coronary occlusion and the effect of revascularization in beating heart CABG.

[A case of traumatic cardiac contusion accompanied by the rupture of pericardium]

We experienced a case of traumatic cardiac contusion accompanied by the rupture of the pericardium after multiple blunt trauma sustained in a traffic accident. A 26-year-old woman who had suffered from blunt chest and abdominal trauma was admitted to our hospital, being unconscious with multiple severe injuries including pelvic fracture, bilateral hemothorax, and multiple fractures in the extremities. The patient was in a shock status. We performed the transcatheter arterial embolization of the internal iliac arteries to control the bleeding, when aortography showed that the contrast media extravasated toward the left thoracic cavity. Immediately, an operation for blunt chest trauma was performed. Blood was flooding out of the ruptured pericardium because of the contusion of myocardium. The postoperative course was uneventful. Blunt chest trauma is usually accompanied by multisystem injury. Therefore, it is imperative to determine the priority of treatment based on preoperative examination in patients having multiple injuries.

[Surgical results of valvuloplasty for common atrioventricular valve regurgitation in single ventricle]

From 1988 through 1994, 18 patients who had common atrioventricular valve regurgitation associated with single ventricle underwent valvuloplasty. All patients had isomerism heart (right isomerism: 16, left isomerism: 2). The preoperative degree of regurgitation was 3.3 +/- 0.4 (Sellers). Valvuloplasty was performed by two different procedures. Semi-circular annuloplasty was used in nine patients. Dividing the common atrioventricular valve orifice into two parts (bivalvation) with or without annuloplasty was used in nine. The concomitant procedures varied: three patients underwent systemic pulmonary shunt, two underwent repair of total anomalous pulmonary venous drainage, one underwent pulmonary arterial banding, five underwent bidirectional Glenn, shunt, and four underwent Fontan operation. One early death and three late deaths have occurred. The early postoperative degree of regurgitation was reduced to 1.3 +/- 1.0. In nine patients, however, the degree of regurgitation increased late postoperatively. Seven patients were reoperated on because of regurgitation: three patients had valve replacement and four had reannuloplasty. Increased incidence of deterioration of regurgitation in late period was seen in patients under 2 years old and those receiving a concomitant Blalock shunt. Lower event-free rate after 2 years was seen in patients with double inlet right or indeterminate ventricle and those underwent the annuloplasty alone. We conclude that the dividing common atrioventricular valve orifice into two parts with annuloplasty could effectively reduce the regurgitation in most patients with isomerism heart, and the concomitant ventricular unloading operation seems to offer promise for improving long-term results.

[Postoperative pulmonary stenosis after arterial switch operation, comparison in three methods of pulmonary reconstruction: modified Pacifico, autologous pericardial patch, and equine pericardial patch]

To prevent postoperative pulmonary stenosis in arterial switch operation for transposition of the great arteries, pulmonary reconstruction without patch augmentation (modified Pacifico method: Pa-group) and reconstruction using W-shaped fresh autologous pericardium (AW-group) were introduced instead of the former method using equine pericardium (XW-group). Postoperative pulmonary stenosis (RV-PA pressure gradient greater than 30 mmHg) was not seen among the 17 cases in the Pa-group (0%), and was seen in 2/14 (14.3%) in the AW-group and in 4/14 (29%) in the XW-group. Progressive increase in pressure gradient was seen in the XW-group in the midterm cardiac catheterization (p < 0.01), but such tendency was not observed in the Pa-group and the AW-group. Sectional area at the pulmonary valve ring, at the anastomotic site in the main pulmonary artery, and at the pulmonary branches just distal to the bifurcation, standardized by the body surface area, increased in the Pa-group and the AW-group, but were unchanged or slightly decreased in the XW-group in the midterm cardiac angiography. We believe that postoperative pulmonary stenosis can be best avoided if modified Pacifico method is used. The cases in which postoperative pulmonary stenosis or coronary artery compression is anticipated such as those with side-by-side aortopulmonary relationship or after pulmonary artery banding, should be operated upon using fresh autologous pericardial patch.

Evaluation of new pasty-type implantable devices consisting of poly(epsilon-caprolactone/delta-valerolactone) and Estracyt or estramustine

Biodegradable pasty-type copolyesters with a relatively low molecular weight of 4500 were synthesized by direct copolycondensation of epsilon-caprolactone (CL) and delta-valerolactone (VL) in the absence of catalysts to evaluate in vivo capabilities of the polymer for implantable controlled release devices in drug delivery systems. The devices in cylindrical shape were prepared by the melt-pressing technique using pasty-type copoly(CL/VL) with 53 mol% CL unit, in which Estracyt and estramustine were used as a water soluble and insoluble drug, respectively. The degradation and drug release in vivo of the devices were examined by subcutaneous implantation in the backs of male rats. The degradation of the device was remarkably accelerated by the presence of hydrophilic Estracyt, and was slightly suppressed by hydrohobic estramustine. The estramustine release profile roughly corresponded to the polymer degradation one. It was found that the degradation of the polymer in the device was affected by hydrophilicity of the drug. A reasonable release of estramustine from the device was kept for a period of more than 20 weeks. Furthermore, the release of the drugs in vivo was able to lead to an atrophy of accessory sex organs such as ventral prostates (VP) and right-side seminal vesicle (SV), resulting in pharmacological influence.

Application of PHYCON 6600 to achieve sustained release of an antitumor drug (carmofur)

This study attempted to develop sustained release implantable dosage forms based on PHYCON 6600, a new silicone gel. The solid gel is prepared at ambient temperature by polymerization of two basic components (PHYCON A and PHYCON B solutions) for about 1 h. The application we explored was the use of implantable PHYCON-drug composites in tumor therapy. Carmofur (1-hexylcarbamoyl-5-fluorouracil, HCFU) was chosen as a practical antitumor drug. Using an in vitro dissolution test, near zero-order release rate was observed over a period of about 35 days. The amount of drug released by the 'burst phenomenon' was found to be less than the HCFU toxic dose. In vivo studies of antitumor activity were carried out by measuring the lifespan of lymphoma-inoculated mice (ILS). The increase in lifespan (38.5%) following intraperitoneal administration of the PHYCON formulations was similar to that (36.4%) following injection of the drug alone for 5 days. Our results suggest that the injectable and implantable sustained release formulations of the antitumor drug in PHYCON might be suitable for tumor chemotherapy.