PURPOSE: The objective of this study is to evaluate the heparin effect for a viability of random-pattern dorsal flap in hairless mouse. METHODS: A caudally-based random dorsal flap, measuring 1.5 x 5 m, was designed and heparin was applied topically after microneedling. Twenty five male hairless mice were randomly divided into five groups: control (Group 1, n=5); received only microneedling (Group 2, n=5), only heparin (Group 3, n=5), microneedling with saline (Group 4, n=5), and microneedling with heparin group (group 5, n=5) to the flap during 7 days. The number of the capillaries were compared between the experimental groups and control group with respect to neovascularization after heparin application using imaging analysis program under hematoxylin-eosin stain. The capillary blood flow was measured by laser Doppler flowmetry. After seven days each animal was evaluatedfor the percentage area of the flap survival. Mann- Whitnety U test and Kruskal-Wallis statistical analysis of survival relationships was performed. RESULTS: It can be observed increased number of the blood vessels in the experimental groups however it was not statistically significant. Blood flow of the haparin with microneedling group maintained higher than other experimental groups. Treated microneedling and heparin mice were significantly better flap viability than in controls (flap survival 67% and 54.4 mm2 respectively; p< 0.01). Positive correlation was shown between flap survival rate and laser Doppler flux value only at first day after surgery. CONCLUSION: Heparin has a beneficial effect on capillary flow and improve peripheral circulatory disturbances in random pattern flaps.
Animals ; Blood Vessels ; Capillaries ; Heparin ; Humans ; Laser-Doppler Flowmetry ; Male ; Mice ; Mice, Hairless ; Skin ; Survival Rate

The latissimus dorsi myocutaneous flap was one of the first methods of breast reconstruction described. However, a standard latissimus dorsi flap alone often does not provide sufficient volume for breast reconstruction and has been performed with an implant to achieve adequate breast volume. The design of an extended latissimus dorsi flap has evolved to include the parascapular and scapular fat-fascia extension in addition to lumbar fat for additional volume. The main advantage of the extended latissimus dorsi flap is that it can provide autologous tissue to the reconstructed breast without an implant and with an acceptable donor site contour and scar. The extended latissimus dorsi flap elevation is of dissection in plane just beneath the fascia superficialis, leaving the deep fat attached to the surface of the muscle. The fat left attached to the surface of the muscle is well vascularized by the perforators coming from the muscle itself. Division of the humeral attachment of the muscle is performed for an adequate excursion of the flap. Denervation of the thoracodorsal nerve is recommended for preventing postoperative involuntary muscle contraction. Patients should be warned of the potential donor site seroma. The extended latissimus dorsi flap proved to be a reliable option for totally autologous breast reconstruction in selected patients. The flap is reliable, and the procedure is technically straightforward and consistent.
Breast ; Cicatrix ; Contracts ; Denervation ; Fascia ; Female ; Humans ; Imidazoles ; Mammaplasty ; Muscle, Smooth ; Muscles ; Nitro Compounds ; Seroma ; Tissue Donors

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that predominantly affects women of reproductive age. Risk of SLE flare during pregnancy is dependent on disease activity of SLE and proteinuria at the time of conception, which affect pregnancy outcome. We report on three patients who developed renal flares during pregnancy after remission of lupus nephritis before pregnancy. Two patients were treated successfully, with pregnancy outcomes of live births however, another patient's pregnancy was terminated with induced abortion. For SLE patients, family planningis needed until disease activity of SLE has been stable for at least six months prior to the pregnancy. Nevertheless, flares of lupus could develop and influence maternal and fetal outcome. Therefore, renal flares during pregnancy should be recognized and treated immediately.
Abortion, Induced ; Female ; Fertilization ; Humans ; Live Birth ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Nephritis ; Pregnancy ; Pregnancy Outcome ; Pregnant Women* ; Proteinuria

Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered.
Acute Disease ; Acute Kidney Injury/diagnosis/therapy ; Antibodies, Viral/analysis ; Hepatitis A/complications/*diagnosis/immunology ; Humans ; Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology ; Macrophages/immunology ; Male ; Middle Aged ; Nephritis, Interstitial/complications/*diagnosis ; Renal Dialysis ; T-Lymphocytes/immunology

Although several urinary biomarkers have been validated as early diagnostic markers of acute kidney injury (AKI), their usefulness as outcome predictors is not well established. This study aimed to determine the diagnostic and prognostic abilities of urinary liver-type fatty acid-binding protein (L-FABP) in heterogeneous critically ill patients. We prospectively collected data on patients admitted to medical and surgical intensive care units (ICUs) from July 2010 to June 2011. Urine neutrophil gelatinase-associated lipocalin (NGAL) and L-FABP at the time of ICU admission were quantitated. Of the 145 patients, 54 (37.2%) had AKI defined by the Acute Kidney Injury Network (AKIN) criteria. AKI patients showed significantly higher level of urinary NGAL and L-FABP and also higher mortality than non-AKI patients. The diagnostic performances, assessed by the area under the ROC curve, were 0.773 for NGAL and 0.780 for L-FABP, demonstrating their usefulness in diagnosing AKI. In multivariate Cox analysis, urinary L-FABP was an independent predictor for 90-day mortality. Urinary L-FABP seems to be promising both for the diagnosis of AKI and for the prediction of prognosis in heterogeneous ICU patients. It needs to be further validated for clinical utility.
Acute Kidney Injury/*diagnosis/mortality/surgery ; Acute-Phase Proteins/urine ; Adult ; Aged ; Area Under Curve ; Biological Markers/urine ; Critical Illness ; Fatty Acid-Binding Proteins/*urine ; Female ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Lipocalins/urine ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Proto-Oncogene Proteins/urine ; ROC Curve

Autoimmune pancreatitis is a recently established clinicopathologic entity often associated with various types of other autoimmune diseases. We report a case of postrenal acute kidney injury (AKI) due to retroperitoneal fibrosis associated with autoimmune pancreatitis. The seventy one year old male patient was admitted because of oliguria and lower extremity edema. He had been diagnosed to have autoimmune pancreatitis and retroperitoneal fibrosis by increased serum IgG and IgG4 level with the presence of rim like attenuation around pancreas and the retroperitoneal fibrosing mass in abdominal CT scan 1 year ago but was lost to follow up. Magnetic resonance cholangiopancretogram and follow up abdominal CT scan showed progressed retroperitoneal fibrosis with newly developed bilateral hydronephrosis and atrophied left kidney despite partial improvement in pancreatitis. Because of progressively rising serum creatinine and oliguria, percutaneous nephrostomy in right kidney was performed. Steroid treatment was initiated with insertion of double J catheter at right ureter and renal function gradually returned. We report here a rare case of postrenal AKI developed in unilateral functioning kidney complicated by combined retroperitoneal fibrosis and autoimmune pancreatitis.
Acute Kidney Injury ; Autoimmune Diseases ; Catheters ; Creatinine ; Edema ; Follow-Up Studies ; Humans ; Hydronephrosis ; Immunoglobulin G ; Kidney ; Lost to Follow-Up ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Male ; Nephrostomy, Percutaneous ; Oliguria ; Pancreas ; Pancreatitis ; Retroperitoneal Fibrosis ; Ureter

Secondary hyperparathyroidism is a common complication of chronic kidney disease and known to be associated with soft tissue calcification affecting patients' morbidity and mortality. However few cases of intestinal calcification related to secondary hyperparathyroidism have been reported. Herein we report a case of peritonitis complicating small intestinal perforation in a patient who had undergone peritoneal dialysis and had sustained hyperparathyroidism. Diffuse calcifications and perforations in small intestine were identified in abdomino-pelvic CT scan as well as in resected small intestine. Because of relapsing microperforation and resultant intra-abdominal abscess, the patient has been in fasting status depending on total parenteral nutrition for over 8 months after surgery.
Abdominal Abscess ; Fasting ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Intestinal Perforation ; Intestine, Small ; Parenteral Nutrition, Total ; Peritoneal Dialysis ; Peritonitis ; Renal Insufficiency, Chronic

BACKGROUND: Mycobacterial culture is the gold standard test for diagnosing tuberculosis (TB), but it is time-consuming. Polymerase chain reaction (PCR) is a highly sensitive and specific method that can reduce the time required for diagnosis. The diagnostic efficacy of PCR differs, so this study determined the actual sensitivity of TB-PCR in tissue specimens. METHODS: We retrospectively reviewed 574 cases. The results of the nested PCR of the IS6110 gene, mycobacterial culture, TB-specific antigen-induced interferon-γ release assay (IGRA), acid-fast bacilli (AFB) staining, and histological findings were evaluated. RESULTS: The positivity rates were 17.6% for PCR, 3.3% for the AFB stain, 22.2% for mycobacterial culture, and 55.4% for IGRA. PCR had a low sensitivity (51.1%) and a high specificity (86.3%) based on the culture results of other studies. The sensitivity was higher (65.5%) in cases with necrotizing granuloma but showed the highest sensitivity (66.7%) in those with necrosis only. The concordance rate between the methods indicated that PCR was the best method compared to mycobacterial culture, and the concordance rate increased for the methods using positive result for PCR or histologic features. CONCLUSIONS: PCR of tissue specimens is a good alternative to detect tuberculosis, but it may not be as sensitive as previously suggested. Its reliability may also be influenced by some histological features. Our data showed a higher sensitivity when specimens contained necrosis, which indicated that only specimens with necrosis should be used for PCR to detect tuberculosis.
Diagnosis* ; Granuloma ; Methods ; Necrosis ; Polymerase Chain Reaction* ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis*

Eosinophilic pleural effusion (EPE) is defined as a pleural effusion that contains at least 10% eosinophils. EPE occurs due to a variety of causes such as blood or air in the pleural space, infection, malignancy, or an autoimmune disease. Undifferentiated connective tissue disease (UCTD) associated with eosinophilic pleural effusion is a rare condition generally characterized by the presence of the signs and symptoms but not fulfilling the existing classification criteria. We report a case involving a 67-year-old man with UCTD and EPE, who has been successfully treated with a single intrapleural corticosteroid injection.
Aged ; Autoimmune Diseases ; Connective Tissue Diseases* ; Connective Tissue* ; Eosinophilia ; Eosinophils* ; Humans ; Pleural Effusion*

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies worldwide. Approximately 10%–15% of the CRC cases have defective DNA mismatch repair (MMR) genes. Although the high level of microsatellite instability status is a predictor of favorable outcome in primary CRC, little is known about its frequency and importance in secondary CRC. Immunohistochemical staining (IHC) for MMR proteins (e.g., MLH1, MSH2, MSH6, and PMS2) has emerged as a useful technique to complement polymerase chain reaction (PCR) analyses. METHODS: In this study, comparison between the MMR system of primary CRCs and paired liver and lung metastatic lesions was done using IHC and the correlation with clinical outcomes was also examined. RESULTS: Based on IHC, 7/61 primary tumors (11.4%) showed deficient MMR systems, while 13/61 secondary tumors (21.3%) showed deficiencies. In total, 44 cases showed proficient expression in both the primary and metastatic lesions. Three cases showed deficiencies in both the primary and paired metastatic lesions. In 10 cases, proficient expression was found only in the primary lesions, and not in the corresponding metastatic lesions. In four cases, proficient expression was detected in the secondary tumor, but not in the primary tumor. CONCLUSIONS: Although each IHC result and the likely defective genes were not exactly matched between the primary and the metastatic tumors, identical results for primary and metastatic lesions were obtained in 77% of the cases (47/61). These data are in agreement with the previous microsatellite detection studies that used PCR and IHC.