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Extraskeletal neoplasms with osteoclast-like giant cells are very rare. These tumors are most frequently reported in the breast and pancreas, and but rarely in other sites. We report a case of duodenal malignant tumor with osteoclast-like giant cells. The patient was a 76-year-old man who presented with vomiting. Computed tomography, magnetic resonance imaging, and gastrointestinal endoscopy revealed a giant tumor in the ascending part of duodenum. Biopsy specimens showed an undifferentiated malignant tumor with benign multinucleated giant cells. Immunohistochemical staining indicated that the tumor cells were reactive with vimentin, but not with epithelial markers or the other mesenchymal markers, and the multinucleated giant cells were reactive with CD68. Thus, we diagnosed a malignant tumor of the ascending part of duodenum with osteoclast-like giant cells. To the best of our knowledge, this is the first case of duodenal malignant tumor with osteoclast-like giant cells in Japan.

A 20 year-old man presented to emergency room with severe left-sided flank pain. Urinalysis showed hematuria and he was referred to the urology department. KUB, DIP and retrograde pyelography (RP) revealed multiple renal stones, left hydronephrosis (grade 2) and ureteropelvic junction obstruction (UPJO). Abdominal CT revealed shortened nutcracker distance and renal angiography showed left renal vein hypertension. From these findings, diagnosis of nutcracker syndrome was made. Transposition of the left renal vein, dismembered pyeloplasty and left pyelolithotomy were performed simultaneously. 2 months after the procedure, his symptom and hematuria disappeared. 3 months after the procedure, DIP revealed improvement of hydronephrosis (grade 1) and CT showed elongation of nutcracker distance. In 12 months follow-up, there was no recurrence of symptom and hydonephrosis. To the best our knowledge, there has been no report of UPJO associated with nutcracker syndrome and the simultaneous treatment for the both diseases.

Human cytomegalovirus (HCMV) is a ubiquitous beta human herpesvirus type 5. Compared to other human herpesviruses, HCMV is the largest, with a genome of approximately 235 kb containing approximately 250 ORFs with the potential to encode proteins. Usually, HCMV asymptomatically infects the host during childhood, and establishes life-long latency. The infection is life-threatening for infants and immunocompromised individuals, because of direct cytopathicity by viral replication, causing systemic organ injuries. Intrauterine infection occasionally causes microcephaly, sensorineural hearing loss and mental retardation. HCMV genome contains a number of accessory genes. Most of them are engaged in immune evasion or inhibition of cell death, possibly, resulting in a symbiosis between virus and host. CD34-positive myeloid progenitor cells are considered as a site of latency. However, the molecular mechanisms by which HCMV establishes and maintains latency and reactivates remain poorly understood. Recently in Japan, the decline of maternal HCMV seropositivity may increase the risk of intrauterine infection. It needs to immediately establish the protection against transplacental HCMV infection, such as a new type of neutralizing antibody or vaccine, which effectively interferes viral entry specific to endothelial and epithelial cells. Furthermore, HCMV infection might be considered as the most important factor for driving immune senescence in the elderly.

In recent years, experiences with performing off-pump coronary artery bypass (OPCAB) has increased dramatically. Many early reports suggest that this approach may improve outcome by lowering postoperative complications. The benefit of this procedure to elderly patients seems appealing but is not well studied. We sought to review our experience with OPCAB in octogenarians with acute coronary syndrome (ACS) to better define the potential benefit of this approach in this high-risk group of patients. Until March 2003, OPCAB was performed in 21 octogenarians (10 men and 11 women with mean age of 82.9 +/- 2.8 years) with ACS at the department of cardiovascular surgery of National Kanazawa Hospital. Two had myocardial infarction and 3 unstable angina. Mean left ventricular ejection function was 41.2%. 14 patients had a history of previous cerebral infarction. All procedures were completed without hemodynamic deterioration and conversion to on-pump coronary artery bypass grafting (CABG). There was no operative mortality and no occurrence of major complications such as low output syndrome, re-exploration for bleeding, cerebral infarction, perioperative myocardial infarction, and mediastinitis. And no further deterioration of organ function occurred in patients with preexisting central nervous system dysfunction or kidney. Peak CK-MB concentrations after surgery were within normal limits. This study demonstrates that CABG can be performed safely on high-risk ACS patients 80 years of age and older without the use of cardiopulmonary bypass. OPCAB may be the operation of choice for octogenarians with ACS requiring surgical myocardial revascularization.

Recently, off-pump coronary artery bypass grafting (OPCAB) has been rediscovered and spread to avoid the deleterious effect of cardiopulmonary bypass. In OPCAB, surgical exposure of Cx grafting site often threats the hemodynamic stability. We retrospectively analysed the 13 patients with acute coronary syndrome due to LMT lesion who underwent emergent OPCAB to accomplish the safe Cx grafting. We assessed the intraoperative hemodynamic changes and early results of OPCAB through the use of new devices and techniques. Myocardial tissue oxygen saturation was measured by near-infra red spectroscopy during OPCAB. All procedures were completed without hemodynamic deterioration and conversion to cardiopulmonary bypass. No hospital deaths or complications were noted. The early patency rate was 100 percent and perioperative maximal CK-MB was 16.6 +/- 4.7 IU/l. Concomitant use of ischemic preconditioning and KATP opener, oxidative radical scavenger, PD III inhibitor, ameliorated ischemic cardiac dysfunction during occlusion of the coronary artery and improved the postischemic functional recovery. These results suggest that intra-operative compound management may decrease the risk of Cx grafting of OPCAB.

The blood and tissue levels of pirarubicin (THP) were studied in dogs by HPLC analysis. The THP (1.5 mg/kg) was infused from the bifurcation of internal iliac artery. We measured the concentration of THP after 1 or 2 hours of intra-arterial infusion (IA) and compared with the concentration of THP administered intravenously (IV). The plasma levels of THP following IA rapidly disappeared the same as for IV. The blood cell level of THP following both IA and IV was significantly higher than the plasma level. The bladder mucosa and muscle levels of THP following IA were about 8 times as high as that of IV. The bladder muscle level of THP 2 hours after IA was about twice as high as after 1 hour and the same as the bladder mucosa level of THP after both 1 and 2 hours. It is considered that THP by the present method may have the transition from the mucosa to the muscle in the bladder. In the other intrapelvic tissues (perivesical adipose tissue, pelvic lymph node and prostate), IA also had higher concentrations compared with IV. However, the extrapelvic tissues (heart, liver and kidney) levels of THP following IA were the same as those for IV. It was concluded that THP was a reasonable agent for IA chemotherapy for bladder cancer.

A case of an aggressive angiomyxoma of the vulva in a 38-year-old lady is reported. The tumor was gelatinous and 12 x 8 x 7 cm in size. Histologically, spindle or stellate-shaped tumor cells and blood vessels were found distributed in a myxoid stroma. It was found that the tumor cells were immunoreactive to vimentin but negative to desmin and smooth muscle specific actin. Ultrastructurally the tumor cells had an intercellular junction, an abundant, rough endemic reticulum, and intracytoplasmic filaments, but no focal densities of the filaments and the basal lamina. These findings have revealed that this tumor consisted of myofibroblastic cells resembling fibroblasts rather than myofibroblasts.