The aim of this study was to assess the association between perinatal status and insulin resistance in neonates during the birth period. The subjects were 49 neonates (27 boys, 22 girls) who had been admitted to the neonatal intensive care unit at Nihon University Itabashi Hospital within 2 h after birth. We retrospectively analyzed the associations between perinatal status (Apgar score, sex, gestational age, birth weight, etc.) and insulin resistance (assessed by plasma immunoreactive insulin (IRI), plasma cortisol, homeostatic model analysis ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), plasma glucose/IRI ratio, and plasma IRI/cortisol ratio) based on the medical records. The preterm neonates had significantly lower plasma cortisol levels (P = 0.02) and significantly higher plasma IRI/cortisol ratios (P = 0.04) compared with the full-term neonates. No significant differences were found in any of the parameters between neonates with asphyxia and those without. In cases with hyperinsulinemia, male predominance was significant (P < 0.01) in neonates with hypoglycemia; furthermore, birth weight, HOMA-R, and plasma glucose/IRI ratio tended to be lower (P = 0.07, P = 0.01 and P < 0.01, respectively), while QUICKI and plasma IRI/cortisol ratio tended to be higher (P = 0.02 and P = 0.09, respectively) in neonates with hypoglycemia compared with those without. One possible reason for these findings could be the immaturity of the hypothalamic-pituitary-adrenal axis in preterm infants. There was no significant correlation between perinatal status and the indices of insulin resistance in neonates during the birth period.
We examined the pressure resistance of mechanical sutures in the bronchial stumps in 20 patients following lobectomy. The Echelon® and EndoGIA® automatic suturing devices were used for 10 cases each. Pressure measurements were conducted in a submerged state. The bronchial stump was closed and the distal side of the bronchus clamped. The pressure tube (an 18 G infusion needle) was inserted into the bronchus to allow the injection of air and measure pressure. The mean pressure did not differ significantly in the Echelon® and EndoGIA® groups (112.5 cmH2O vs. 113.5 cmH2O). Sufficient pressure resistance was observed, considering that airway pressure during expiration is usually 20-30 cmH2O. However, there have been some reports showing that many mechanical suturing devices lead to a higher incidence of bronchial stump fistula compared with manual sutures. In the automatic suturing device, the operator cannot freely adjust the tightness. The choice of the stapler and crushing of the bronchus should be considered before stapling in each patient and in consideration of the characteristics of the bronchus.
Selective estrogen receptor modulators (SERMs) have been used to treat patients with estrogen receptor-positive breast cancer. One SERM, toremifene (TOR), has been associated with increased risk of endometrial cancer, polyps, and other complications. Herein, we present a case of microglandular hyperplasia (MGH) of the uterine cervix in a breast cancer patient who had been treated with TOR for 4 years. An 81-year-old woman exhibited an enlarged uterus on CT examination and transvaginal ultrasonography revealed endometrial thickening. Cervical and endometrial cytology showed no malignant cells. MGH was present in the endometrial biopsy specimen. Six months after discontinuation of TOR, MRI showed that the endometrial thickening persisted. Therefore, we could not rule out existing malignant endometrial lesions. Hysterectomy was performed and the pathological findings included endometrial cystic changes and MGH of the cervix with no malignancy. While we did not find any malignant cells, patients with endometrial thickening should be monitored even when the cytology is negative.
A 14-year-old boy with hypertrophic cardiomyopathy experienced ventricular fibrillation while running in his schoolyard. He was resuscitated and admitted to our hospital. Delayed enhancement cardiac magnetic resonance imaging revealed asymmetric ventricular septal hypertrophy and delayed enhancement of the ventricular septum. Monomorphic ventricular tachycardia (VT) was induced by double ventricular extrastimuli. During electroanatomical mapping, a low voltage area was found in the right ventricle, but none was found in the left ventricular endocardium. Pace-mapping from the anterior right ventricular outflow tract, i.e., the low voltage area, revealed delayed potentials, and pacing at this site generated an 85% morphological match to the induced VT. Endomyocardial biopsy of the right ventricular septum revealed differences in myocyte size and myocardial disarray, along with moderate interstitial fibrosis. A cardioverter defibrillator (ICD) was implanted. Genetic testing identified a novel heterozygous missense mutation in the cardiac myosin heavy chain gene.
An 88-year-old man underwent partial jejunectomy in 2012 for a jejunal gastrointestinal stromal tumor. Ten months after the surgery, he was diagnosed as having an intra-peritoneal recurrence in the vicinity of the 3rd to 4th portion of the duodenum, and underwent treatment with imatinib (400 mg/day). After two weeks, the treatment was stopped due to acneiform eruption. However, the tumor was reduced, and the imatinib treatment was resumed at a dose of 100 mg/day. The acneiform eruption improved and the recurrent tumor with the cystic degeneration decreased remarkably over the course of 27 months.
Herein, we report 2 cases of laparoscopic surgery for recurrent inguinal hernia after transabdominal preperitoneal repair (TAPP). It is not easy to enrich laparoscopic operative skill of TAPP earlier. However, TAPP enables the evaluation of potential recurrence, to accurately diagnose the type of hernia, and simultaneous repair of the hernia orifice.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related complication that is clinically difficult to diagnose. PTTM is pathologically characterized by pulmonary vascular tumor emboli and intimal proliferation leading to pulmonary artery stenosis or obstruction. A 62-year-old man was admitted to the hospital because of worsening exertional dyspnea. We clinically diagnosed this as pulmonary thrombotic embolism (PTE) because of the high serum D-dimer level and right ventricular load, as demonstrated by cardiac ultrasound, despite the fact that enhanced chest CT did not show any pulmonary thrombosis. Despite treatment for PTE, he died of acute respiratory failure the day after admission. Autopsy revealed that he had gastric cancer (signet-ring cell carcinoma) and pulmonary vascular and lymphatic tumor emboli with organized thrombosis and vascular intimal proliferation consistent with PTTM. PTTM should be considered in the differential diagnosis of progressive acute respiratory failure of unknown origin.