Mycobacterium bovis-induced Aneurysm after Intravesical Bacillus Calmette-Guérin Therapy: A Case Study and Literature Review

Mycobacterium bovis infection after intravesical Bacillus Calmette-Guérin (BCG) therapy is rare. A 65-year-old Japanese man with history of bladder cancer and intravesical BCG therapy, presented with low-grade fever. An aneurysm with perianeurysmal fluid was suspected and endovascular aortic repair was performed. After 160 days, he developed blood-streaked sputum and computed tomography images revealed that the perianeurysmal fluid area was increasing in size. A multiplex polymerase chain reaction using sputum identified M. bovis. Treatment with anti-tuberculosis drugs reduced the size of the perianeurysmal fluid area. After intravesical BCG therapy, the possibility of M. bovis infection should be considered, thus further investigations are required.

Cholesterol Crystal Embolism Induced by Direct Factor Xa Inhibitor: A First Case Report

An 80-year-old man presented at our hospital with renal failure. He had been treated with edoxaban, an oral direct factor Xa inhibitor, for deep vein thrombosis for 10 months prior to admission. Although the pulses in his bilateral pedal arteries were palpable, cyanosis was present in the bilateral toes. Laboratory data indicated azotemia and eosinophilia. A skin biopsy confirmed a diagnosis of cholesterol crystal embolism (CCE). Because no invasive vascular procedure was performed, we assumed that CCE was related to edoxaban. To the best of our knowledge, this is the first case report suggesting CCE induced by an Xa inhibitor.

Vesicular eruption in a 2-year-old boy

A bath with scented soap prompted a flare of the boy's eczema. Days later, he was hospitalized with diffuse erosions covering 90% of his body. What was the cause?

Heart valve engineering: decellularized aortic homograft seeded with human cardiac stromal cells

BACKGROUND AND AIM OF THE STUDY

The adult human heart contains a cardiac mesenchymal stromal cell (CStC) population with residual cardiovascular plasticity. The study aim was to investigate the ability of CStCs to populate decellularized aortic homograft leaflets, without mechanical stimulation.

METHODS

The ability of CStCs to acquire valve endothelial and interstitial cell phenotypes was tested using in vitro assays. First, trypsin-decellularized aortic leaflets were seeded with CStCs under static conditions; tissue section analyses were then performed before and after decellularization, and at 10, 20, and 30 days after reseeding.

RESULTS

Following in vitro treatment, the CStCs differentiated along the endothelial lineage, as shown by their capacity to uptake acetylated low-density lipoprotein and to secrete the pro-angiogenic factor, vascular endothelial growth factor. After seeding, CStCs were able to adhere to the leaflet surface, rescuing up to the 90% of the original cell density and expressing the mature endothelial marker, von Willebrandt factor. The CStC supernatants were also positive for matrix metalloprotease-2 (MMP-2), which confirmed the ability of these cells to penetrate within the leaflet structure; this also suggested that CStCs, once engrafted, would contribute to the extracellular matrix turnover. Accordingly, although at a lower efficiency, CStC repopulation was also evident in the inner portions of the leaflet.

CONCLUSION

Seeded CStCs were able to reconstitute, without mechanical stimulation, an endothelial-like layer and to partially infiltrate decellularized homograft leaflets. Hence, CStCs appear to be a potentially useful cell type for engineered heart valves.

Errors in opioid prescribing: a prospective survey in cancer pain

CONTEXT

Cancer pain is debilitating and has multidimensional consequences. It can be treated adequately in up to 90% of patients by following pain management guidelines. Nevertheless, inadequate pain control remains a global problem.

OBJECTIVES

We surveyed prescribing patterns in patients referred to our Palliative Medicine Program (PMP) to identify common errors in opioid use.

METHODS

Consecutive cancer patients seen by our PMP were prospectively surveyed for the presence of pain and errors in opioid prescribing at the time of initial consultation. Our recommendations to correct and optimize pain management also were recorded.

RESULTS

One hundred eighty-six consecutive cancer patients were screened. One hundred seventeen (63%) had cancer pain, 151 opioid prescribing errors were detected, and 147 different recommendations were made. Most common were failure to order around-the-clock opioids for constant pain, and the failure to treat or prevent opioid side effects. Multiple errors were more common in females, but the sex difference did not reach statistical significance. There was no difference in the errors by pain severity or reason for consultation.

CONCLUSION

Opioid prescribing errors were common. Females may be at greater risk of multiple errors. A PM consultation program is effective in identifying and correcting a wide variety of opioid prescribing errors.

Identification and characterization of a novel peptide ligand of Tie2 for targeting gene therapy

Tyrosine kinase with immunoglobulin and epidermal growth factor homology domain-2 (Tie2) has been considered as a rational target for gene therapy in solid tumors. In order to identify a novel peptide ligand of Tie2 for targeted gene therapy, we screened a phage display peptide library and identified a candidate peptide ligand NSLSNASEFRAPY (designated GA5). Binding assays and Scatchard analysis revealed that GA5 could specifically bind to Tie2 with a dissociation constant of 2.1x10(-8)M. In addition, we showed that GA5 was internalized into tumor cells highly expressing Tie2. In the biodistribution assay, (125)I-GA5 was mainly accumulated in SPC-A1 xenograft tumors that express Tie2. In gene delivery studies, GA5-conjugated polyethylenimine vector could achieve greater transgene transduction than non-targeted vectors both in vitro and in vivo. Tumor growth inhibition was observed in SPC-A1 xenograft-bearing mice that received eight intratumoral injections of GA5-polyethylenimine/p53 complexes in 3 weeks. The difference in tumor volume between the experiment and control groups was significant (P<0.05). Our results showed that GA5 is a potentially efficient targeting element for cancer gene or molecular therapy.

Endoscopic video-assisted breast surgery: procedures and short-term results

BACKGROUND

We devised a new endoscopic operation for breast diseases. We report the aesthetic and treatment results of this procedure.

METHODS

A 2.5-cm axillary skin incision was made for a single approaching port, and a working space was created by retraction. Under video assistance, we resected the mammary gland partially or totally, and in the case of malignant diseases we also performed a sentinel lymph node biopsy and dissected axillary lymph nodes (levels I and II).

RESULTS

From December 2001 through April 2005, we performed endoscopic video-assisted breast surgery (VABS) in 100 patients with breast diseases. The diseases were benign in 18 patients and malignant in 82 patients. Of the malignant diseases, 80 underwent breast-conserving surgery and 2 underwent skin-sparing mastectomy. There was no significant difference in operation time, blood loss, or blood examinations related with the acute phase reaction between VABS and conventional breast-conserving procedures. All surgical margins were negative on examination of permanent histological preparations. The wounds healed without noticeable scarring. The original shapes of the breast were preserved. All patients expressed their great satisfaction with VABS.

CONCLUSIONS

VABS can be considered as a surgical option and can provide aesthetic advantages for patients with breast disease.

Long term results after transpupillary thermotherapy in eyes with occult choroidal neovascularisation associated with age related macular degeneration: a prospective trial

AIM

To evaluate long term results after transpupillary thermotherapy (TTT) in eyes with exudative age related macular degeneration.

METHODS

In a prospective clinical study eyes with occult or predominantly occult choroidal neovascularisation and no pretreatment were scheduled to have a TTT with a power of 630 mW. Visual acuity for far and near distances as well as contrast sensitivity were evaluated 6, 12, and 24 months postoperatively and statistically analysed.

RESULTS

47 eyes fulfilled the inclusion criteria. Overall, 70% of the patients showed an improved (14%) or had unchanged (56%) ETDRS vision after 24 months. Reading vision was stabilised (51%) or better (5%) in 56% of the eyes at this time. However, the increasing number of eyes with severe deterioration resulted in a significant decrease of both parameters over time (p = 0.0002 and p = 0.0003, respectively). Contrast sensitivity could be maintained (70%) or improved (9%) in 79%. Statistical analyses indicated a trend but no significant decrease over time (p = 0.056).

CONCLUSION

Although in the majority of patients far and near distance acuity could be stabilised on average a significant decrease over time after TTT was observed. Statistical comparison of months 12 and 24 showed no further deterioration.

Single-incision, minimally invasive total hip arthroplasty: length doesn't matter

A pilot cohort study of 60 primary total hip arthroplasties (THAs) was undertaken to evaluate the technical aspects and possible clinical advantages of performing THA through a single-incision, minimally invasive, 10-cm-length, direct lateral approach compared with the same approach performed through a standard-length skin incision. We could not show any significant difference with regard to operative time; in-hospital equianalgesic opioid consumption; postoperative blood loss; complications; hospital length of stay; or flexion, Harris Hip and Oxford Scores at 6 weeks' postoperatively. Restricting the length of skin incision for THA performed through a direct lateral approach does not appear to afford any clinical advantage to the patient in the short term. The mini-exposure creates technical challenges that have the potential to adversely affect primary THA outcome.