Hiroaki Kanaya

Focal Segmental Glomerular Hyalinosis and/or Sclerosis in Rats with Congenital Unilateral Hydronephrosis

Focal segmental glomerular hyalinosis and/or sclerosis (FSHS) was observed in five Wistar‐Imamichi rats with congenital unilateral hydronephrosis (CUH rats). Marked proteinuria (164.9+138.4mg/day) was observed in the CUH rats. Immunoperoxidase staining for IgM, C3 and IgG was positive in the glomerull, showing in a focal, segmental pattern that corresponded to the areas of FSHS seen by light microscopy. These glomerular findings were extremely similar to those of human focal glomerular sclerosis (FGS). FSHS was found to be common to both the hydronephrotic kidney and the contralateral kidney without hydronephrosis. Morphometry revealed that the glomerular area of the juxtamedullary glomeruli was greater than that of superficial glomeruli in control rats (11,037 μm2 vs. 6,847 μm2). On the other hand, glomerular hypertrophy was observed in non‐sclerotic glomeruli of CUH rats (superficial glomeruli; 12,477–16,123 μm2, juxtamedullary glomeruli; 14,635–18,418 μm2). Also, a decreased in the number of glomeruli within the range 1.8‐4.1 per unit area (1 mm2) was seen in CUH rats compared with control rats (mean 4.4). These results suggest that the increased rate of development of FSHS is based on hyperfiltration in the remaining functional nephrons. Acta Pathol Jpn 41: 653–660, 1991.

Case Report: Stab Injuries in theNeck Involving the InnominateArtery

Case Report: Stab Injuries in the Neck Involving the Innominate Artery Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed. Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed.