We report our experience of two cases of refractory cellulitis caused by peripheral micro-arteriovenous fistulas (AVFs) in the lower extremity. The micro-AVFs were so small that they could not be located accurately; further, the patients’ symptoms differed markedly from those previously reported for AVF. AVF is known to cause ischemic symptoms. In contrast, micro-AVF causes congestive symptoms and remains undetected in the majority of patients. Identification of this pathology is crucial to enable effective treatment by the ligation of the incompetent perforator vein that increases venous hypertension, leading to congestive symptoms.

Some hemophilic patients in Japan suffer from infections with both human immunodeficiency virus (HIV) and hepatitis virus because they received contaminated nonheated blood products. Coinfection with HIV appears to accelerate the course of chronic hepatitis. Although powerful antiviral therapy was introduced as HIV treatment and the prognosis of HIV patients was dramatically improved, the risk of rapid progression of hepatitis and carcinogenesis remains for the patients. Recently, we performed surgery for hepatocellular carcinoma (HCC) in two hemophilic patients with HIV and hepatitis C virus (HCV) coinfection. Case 1 was a 52-years-old man who suffered from liver cirrhosis, hypersplenism, and hyperammonemia due to portosystemic shunt. A recent abdominal computed tomography (CT) scan had revealed a low-density area in segment VI of the liver. Splenectomy and partial resection of the liver were performed. Case 2 was a 66-year-old man who had been diagnosed with chronic hepatitis at age 50, and HIV infection at age 52 years. When his serum alpha-fetoprotein level was increased, CT scan of the liver revealed a mass in segment VIII. Subsegmentectmy of the liver was performed. Although the CD4 value in each patient was lower than 200 micro l, the operations were safely carried out and no major complication occurred. Because the chance of encountering HCC patients infected with HIV and HCV is increasing in Japan, we should consider the perioperative care of these patients, as well as the protection of medical workers against HIV infection.

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One-pot synthesis of Mg containing MCM-41 (Mg-MCM-41) materials was carried out by a room temperature (RT) method and by a hydrothermal (HT) method and they were used for aldol condensation of 4-nitrobenzaldehyde and acetone and self-condensation of acetone. The RT method can prepare MCM-41 materials containing large amounts of Mg while maintaining the structural characteristics of MCM-41 even at very low Si/Mg ratios (large Mg loadings), but the HT method cannot. The RT method can also give more active catalysts than the HT method, because the catalysts prepared by the former method are more basic than those prepared by the latter one. The characterization results indicate that Mg atoms in Mg-MCM-41 prepared by the RT method exist as MgO dispersing well on the wall surface of pores, while those in Mg-MCM-41 prepared by the HT method are included in the bulk with a smectite-like structure.

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