Clinical significance of serum cytokine profiles for differentiating between Kawasaki disease and its mimickers.

Objectives: To investigate the clinical significance of serum cytokine profiles for differentiating between Kawasaki disease (KD) and its mimickers.

Methods: Patients with KD, including complete KD, KD shock syndrome (KDSS), and KD with macrophage activation syndrome (KD-MAS), and its mimickers, including multisystem inflammatory syndrome in children, toxic shock syndrome, and Yersinia pseudotuberculosis infection, were enrolled. Serum levels of interleukin (IL)-6, soluble tumor necrosis factor receptor type II (sTNF-RII), IL-10, IL-18, and chemokine (C-X-C motif) ligand 9 (CXCL9) were measured using enzyme-linked immunosorbent assay and compared them with clinical manifestations.

Conversion surgery for stage IV gastric cancer: a multicenter retrospective study.

Background: Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC.

Methods: A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled.

[Stanford Type A Acute Aortic Dissection with Leg Ischemia and Visceral Ischemia].

A 52-year-old man developed Stanford type A acute aortic dissection and suffered severe pain in the back and the chest, and numbness of the left lower limb. Contrast-enhanced computed tomography (CT) revealed occlusion of the left iliac artery due to dissection. The celiac artery was also obstructed and the superior mesenteric artery was severely narrowed, but there was no clear sign of organ ischemia.

[Endovascular Stent Grafting Using Gadolinium-based Contrast Agent and Intravascular Ultrasound in a Patient of Iodinated Contrast Media Allergy].

A 75-year-old male with a history of allergy to iodinated contrast media was referred for the treatment of the left subclavian artery aneurysm. The aneurysm was saccular and maximum diameter over 30 mm. Stent grafting was performed with the use of gadolinium-based contrast agent and intravascular ultrasound (IVUS).

Risk Factors of Patient-Related Safety Events during Active Mobilization for Intubated Patients in Intensive Care Units-A Multi-Center Retrospective Observational Study.

The aim of this study is to clarify the incidence and risk factors of patient-related safety events (PSE) in situations limited to intubated patients in which active mobilization, such as sitting on the edge of the bed/standing/walking, was carried out. A multi-center retrospective observational study was conducted at nine hospitals between January 2017 and March 2018. The safety profiles and PSE of 87 patients were analyzed.

Salvage surgery to treat tumor regrowth after stereotactic body radiotherapy in primary non-small cell lung cancer.

Background: Stereotactic body radiotherapy (SBRT) is considered to be an effective and safe treatment in patients with primary lung cancer. If local recurrence is confirmed following SBRT, surgical treatment is a possibility. The present study aimed to clarify the safety and survival outcomes of salvage surgery in primary lung cancer patients with local recurrence following SBRT.

[Extended Sandwich Patch Repair with the Right Ventricular Approach for Posterior Ventricular Septal Perforation].

Ventricular septal perforation(VSP) is a catastrophic complication of acute myocardial infarction, and posterior VSP reportedly has worse outcomes. We present a case of a 79-year-old man with posterior VSP following acute myocardial infarction. He underwent percutaneous coronary intervention for acute postero-inferior myocardial infarction due to occlusion of the mid-portion of the right coronary artery.

[Complete Anterior Papillary Muscle Rupture with Angiographically Normal Coronary Arteries;Report of a Case].

We present a case of complete anterior papillary muscle rupture (PMR) due to localized papillary muscle infarction, without significant coronary artery disease. A 69-year-old woman was transferred to our hospital because of acute orthopnea and cardiogenic shock. Echocardiography showed severe mitral regurgitation due to anterior PMR, and emergency coronary angiography revealed no obstructive disease in the coronary arteries.

Appearance of large scavenger receptor A-positive cells in peripheral blood: A potential risk factor for severe exacerbation of chronic obstructive pulmonary disease.

Fresh peripheral blood (PB) samples from 432 outpatients with stable chronic obstructive pulmonary disease (COPD) were examined. Patients were classified into Group A (large SRA cells were undetected) and Group B (large SRA cells were detected) and followed-up for 1 year. Patients were further subdivided according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage.

Gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor: a case of a rare malignancy.

Background: A gastric adenosquamous carcinoma (ASC) that produces granulocyte-colony stimulating factor (G-CSF) is an uncommon malignancy with a poor prognosis. Due to the rarity of this lesion, a standard treatment for the disease has not been established.

Case Presentation: We describe a case of a 66-year-old male with a G-CSF-producing gastric ASC who presented with severe anemia and leukocytosis.

Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer.

Background: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques.

Methods: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed.

Acute exacerbation of IPF has systemic consequences with multiple organ injury, with SRA and TNF-α cells in the systemic circulation playing central roles in multiple organ injury.

Background: The pathophysiologic mechanisms underlying acute exacerbation of idiopathic pulmonary fibrosis (IPF) are not fully understood. Few studies have examined autopsy findings in patients who have died from an acute exacerbation of IPF. The pathologic findings in systemic organs have not been described.

[Two Surgical Cases of Loeys-Dietz Syndrome in Childhood].

Loeys-Dietz syndrome( LDS) is a recently recognized autosomal dominant connective tissue disorder. Mutations in the genes encoding transforming growth factor-beta( TGF-β) receptor 1 and (2 TGFBR1, TGFBR2)have been associated with LDS. We report here 2 cases of LDS in childhood.

Comparative analysis of tumor angiogenesis and clinical features of 55 cases of pleomorphic carcinoma and adenocarcinoma of the lung.

Background/aim: Pleomorphic carcinoma (PC) of the lung is a rare tumor that usually has an aggressive clinical course and a poor prognosis. Clinical and pathological features remain unclear. The aim of this study was to determine whether tumor angiogenesis of PC is up-regulated compared to that in adenocarcinoma (AD).

Minute lesions of alveolar damage in lungs of patients with stable idiopathic pulmonary fibrosis.

Aims: To investigate the mechanisms underlying the acute exacerbation of idiopathic pulmonary fibrosis, and in particular the role of minute lesions of alveolar damage.

Methods And Results: We examined surgical lung biopsy samples from 38 patients with stable idiopathic pulmonary fibrosis, and evaluated the association between the foci and development of acute exacerbation. Mild extravasation, probably resulting from lung injury and intra-alveolar oedema fluid, were observed in narrow areas of architecturally intact lung tissue.

[Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.

[Redo off-pump coronary artery grafting through left thoracotomy].

An 80-year-old man successfully underwent reoperative coronary artery bypass grafting( CABG) via left thoracotomy without cardiopulmonary bypass. The proximal end of the saphenous vein graft( SVG)was connected to the thoracic aorta using an automated proximal anastomosis system. Then the SVG routed beneath the pulmonary hilum was anastomosed to the high lateral branch and the anterior descending artery in a sequential mode.

Apoptotic cells in peripheral blood and multiple organ injury.

To evaluate the roles of apoptotic cells in peripheral blood (PB) on multiple organ injury, five patients with hematopoietic stem cell transplantation (HSCT) and one with refractory anemia were examined. The following findings were confirmed. 1) High-dose alkylating agents were administrated as conditioning regimens to all HSCT patients.

Biochemical, cytological and histopathological examination of sudden unexpected death in infancy.

To evaluate the pathophysiological mechanisms underlying sudden infant death syndrome (SIDS), four sudden unexpected death in infancy (SUDI) and four sudden deaths in children over 1 year of age were examined. In the SUDI cases, increased numbers of scavenger receptor A positive (SRA(+) ) cells (4/4), numerous platelet aggregates (3/4), and tumor necrosis factor (TNF)-α(+) cells (4/4) were observed in the peripheral blood (PB) smear preparations. Macrophage colony stimulating factor, interleukin (IL)-6, IL-8, TNF-α and IL-1β all exceeded the normal levels.

Scavenger receptor A index and coronary thrombus in patients with acute ST elevation myocardial infarction.

To examine the relationship between the scavenger receptor A (SRA) index (the number of SRA+ cells observed in 10 high power fields of peripheral blood (PB) smear samples; normal upper limit <30) and coronary thrombus, 389 thrombi obtained from 393 patients with acute ST elevation myocardial infarction were examined. Thrombi were classified into platelets (PT), mixed (MT), fibrin-rich (FT) and organizing thrombi (OT); 387, 269, 57 and 29 cases were detected, respectively. Patients were divided into group A (PT only, 89 cases), B (containing MT and PT but not FT, 243 cases), and C (containing FT, 57 cases).

Appearance of large scavenger receptor A-positive cells and increased small scavenger receptor A positive cells in peripheral blood is associated with mortality in systemic inflammatory response syndrome and multiple organ dysfunction syndrome.

We investigated the association of scavenger receptor A-positive (SRA(+) ) cells in peripheral blood (PB) with mortality in subjects with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). A total of 467 subjects with SIRS (62 of 467 satisfied the diagnostic criteria of MODS) were prospectively examined. The subjects were classified into three groups according to the SRA index (number of small SRA(+) cells in 10 high power field, normal upper limit < 30) and the appearance of large SRA(+) cells as follows: group A, large SRA(+) cells were not detected; group B, large SRA(+) cells were detected but SRA index did not exceed 30; group C, the two factors (appearance of large SRA(+) cells and SRA index > 30) coincided.

Predicting factors of plural hospitalization with pneumonia in low-birthweight infants.

Background: Children with a history of low birthweight (LBW) are often hospitalized with plural episodes of pneumonia after discharge from the neonatal intensive care unit. The aim of this study was to clarify the multiple factors predisposing them to developing three or more hospitalizations with pneumonia and whether the factors are related to their own prematurity. We also aimed to determine a predictable numerical formula for three or more episodes.

[Iterative surgical resections for second primary and local recurrent lung cancer; comparison of lobectomy and limited resection].

During a 24-year period (1986-2009), 74 patients (3.5%) underwent iterative surgical resections for 2nd primary and recurrent lung cancer. Patients are classified to 5 groups: 20 2nd primary lung cancer patients undergoing lobectomy (A), 24 2nd primary lung cancer patients undergoing limited resection (B), 11 2nd primary bronchioloalveolar carcinoma (BAC) patients undergoing limited resection (C), 8 recurrent lung cancer patients undergoing lobectomy (D), and 11 recurrent lung cancer patients undergoing limited resection (E).

[Primary pulmonary synovial sarcoma confirmed by gene expression analysis].

We report a patient who was diagnosed with synovial sarcoma based on gene expression analysis. A 39-year-old male visited a local hospital due to left chest pain. Chest compued tomography (CT) showed a lung tumor located mainly at the lingula of the left lung, and extending to the bifurcation of the upper and lower lobar bronchi.

Histopathological and cytological examination of autopsy cases with multiple organ dysfunction syndromes.

To evaluate the role of small scavenger receptor A (SRA)-positive (SRA(+)) cells and large SRA(+) cells in the peripheral blood (PB) in the pathophysiological mechanisms underlying multiple organ dysfunction syndromes (MODS), 24 autopsy cases with MODS were examined. In addition to histopathological and immunohistochemical examination, cytokine levels of cardiac blood, the SRA index (number of small SRA(+) cells in 10 high power fields, upper limit <30), and appearance of large SRA(+) cells in PB were examined. The SRA index exceeded 30 in all cases.