A 43-year-old male experienced renal infarction (RI) following left upper lobectomy for lung cancer. The patient complained of acute-onset severe left flank pain on the 14th postoperative day. A contrast-enhanced computed tomography (CT) of the abdomen revealed RI by a large wedge-shaped defect in the left kidney. A chest CT scan located the thrombus in the stump (a blind-ended vessel) of the left superior pulmonary vein. Therefore, thromboembolic RI caused by pulmonary vein thrombosis was suspected. Anticoagulation therapy was initiated with heparin and warfarin to treat RI and to prevent further embolic episodes. Two months later, pulmonary vein thrombosis had resolved without the appearance of additional peripheral infarction. This case emphasizes the need to consider thrombus in the stump of the pulmonary vein as a cause of RI.
We examined whether autotransplantation of microvessel fragments (Mvf) and/or myofibroblasts (Mf) into an in vivo skin flap model might improve the survival of the ischemic flap. If so, this could improve blood perfusion, increase blood flow, and improve the survival of the flap. A skin flap was raised on the back of each rat (n = 15 in each group). In the control group, the flap was sutured to the original bed. In the other groups (1) phosphate-buffered saline; (2) autotransplanted Mvf, Mf, or Mvf plus Mf, and (3) a homogenized mixture of Mvf plus Mf was injected into the distal part of the flap. In a further group, Mvf labeled with DiI-acetylated low-density lipoprotein were autotransplanted with Mf into the distal part of the flap, and India ink was perfused through the abdominal aorta 7 days postoperatively. The transplanted Mvf plus Mf group showed better flap survival after 7 days than the other groups (p < 0.02). Labeling with DiI-acetylated low-density lipoprotein showed that transplanted Mvf sent arborizations into the nearby tissue. India ink was found in the lumina within such arborizations. Thus, autotransplanted Mvf may improve the survival of ischemic skin flaps by promoting the early formation of patent connections between Mvf and the host’s microcirculatory system. This apparently requires the presence of Mf.
Rituximab has been approved in Japan for the treatment of intractable nephrotic syndrome, but in cases of childhood-onset disease only; its efficacy and safety in adult-onset disease has yet to be established. This study was undertaken to evaluate the efficacy of rituximab and adverse effects in patients with adult-onset minimal change nephrotic syndrome (MCNS).The study involved 32 childhood-onset cases (mean age at onset: 8.6 years) and 19 adult-onset cases (mean age at onset: 30.6 years) of frequently relapsing steroid-dependent MCNS, all of whom received intravenous rituximab drip infusion (375 mg/m2 body surface area per dose) at 4 time points at 6-month intervals. Relapse frequency, oral dose of immunosuppressants, and adverse effects were compared between the 2 groups.Remission was maintained in all cases in the childhood-onset and adult-onset groups; a significant reduction in relapse frequency was noted during the first 24 months of rituximab therapy (0.3 ± 0.7 times and 0.3 ± 0.6 times in the childhood-onset and adult-onset groups, respectively; P < .001). Oral corticosteroid therapy could be discontinued in 81.3% of cases of the childhood-onset group (26/32 cases) and in 70.6% of cases of the adult-onset group (12/17 cases); the oral corticosteroid dose was reduced significantly to 0.9 ± 2.5 mg/day in the childhood-onset group and to 0.8 ± 1.6 mg/day in the adult-onset group (P < .001). Cyclosporin treatment was also discontinued in 87.5% of cases in the childhood-onset group (21/24 cases) and in 80.0% of cases of the adult-onset group (15/21 cases); the oral cyclosporin dose was reduced significantly to 8.6 ± 27.4 mg/day and 9.2 ± 22.0 mg/day, respectively (P < .001). Regarding adverse reactions, infusion reactions developed at a frequency of 21.1% and 19.7% in both groups, respectively, with no significant inter-group difference (P = .72).Rituximab showed significant efficacy in adult-onset MCNS, with a comparable incidence of adverse reactions to that in childhood-onset cases, suggesting that this drug can also be used safely in adult-onset MCNS.
Renal disease is a common complication of rheumatoid arthritis (RA) and can occur secondary to RA or be induced by therapeutic agents. Recently, glomerular deposition of galactose-deficient IgA1 (Gd-IgA1) was identified as a feature of primary IgA vasculitis with nephritis (IgA-VN). We herein report a case of IgA-VN in an RA patient whose disease activity was controlled by treatment with etanercept. To distinguish between primary IgA-VN and secondary IgA-VN caused by RA or etanercept, we performed immunostaining of renal biopsy sections with the Gd-IgA1-specific antibody KM55. Positive KM55 staining confirmed the diagnosis of primary IgA-VN in a patient with RA.
Cardiac catheterisations and catheter interventions were safe and effective not only in the early postoperative period but also in the very early postoperative period. Catheter interventions for the left-sided heart in the early postoperative period were also safe and effective.
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