Realignment of postoperative cervical kyphosis in children by vertebral remodeling

STUDY DESIGN

This study analyzed radiographically change in the sagittal curvature of the cervical spine after atlantoaxial (C1-C2) posterior fusion in children.

OBJECTIVES

This study clarified the process of spinal remodeling after postoperative cervical deformation in children.

SUMMARY OF BACKGROUND DATA

Postoperative spinal deformations in children are observed frequently. However, there have been only a few reports on postoperative changes in the sagittal curvature of the cervical spine and spinal remodeling after those changes.

METHODS

Between 1979 and 1991, there was a total of 12 children who underwent C1-C2 posterior fusions. The average age at the time of surgery was 9.8 years. The alignment of the cervical spine was classified into four groups (lordosis, straight, kyphosis, and swan-neck deformity). Radiographic findings suggestive of the remodeling were as follows: 1) new bone formation on the anterior vertebral cortex, and 2) increase in body/canal ratio (BCR). The follow-up period averaged 6.2 years.

RESULTS

Postoperative cervical malalignment (kyphosis or swan-neck deformity) occurred in four patients. In all four patients, new bone formation and increase in BCR at the apex of kyphosis were observed. Therefore, there was gradual improvement of the malalignment by vertebral remodeling. This phenomenon was not observed in eight patients with normal alignment.

CONCLUSION

Realignment of postoperative cervical kyphosis by vertebral remodeling was observed in children. The results of this study suggested that remodeling occurred even in the spine, which was similar to the remodeling in long bones.

[Deterioration of liver function following endoscopic injection sclerotherapy of esophageal varices--significance of a new index for liver function "delta TB"]

Changes of liver functions associated with endoscopic injection sclerotherapy (EIS) in which less than 6 ml of 5% ethanolamin oleate was used were investigated in 50 patients with remarkable esophageal varices. The index used for evaluating hepatic reserve was the difference of total bilirubin in serum between immediately and 15 hours after EIS and was tentatively named as "delta TB" (normal range < or = 0.1). In the patients classified as Child-Pugh A (n = 25), Child-Pugh B (n = 19) and Child-Pugh C (n = 6), delta TB was 0.04 +/- 0.30, 0.23 +/- 0.41, and 0.54 +/- 0.21, respectively. One month after the entire sessions of EIS, the changes of liver function tests before and after EIS were compared in 45 cases. It was disclosed that delta TB was elevated in parallel with the severity of their liver dysfunction before EIS. Also, delta TB seems to reflect the prognosis of the patients treated by EIS for some extent, since the survival period of the cases treated by EIS were correlative with delta TB (r = -0.734, p < 0.01), and delta TB of 20 cases who survived for longer than 5 years after EIS was 0.04 +/- 0.32. Therefore, delta TB seems to be a useful marker for estimating the influence of EIS on liver function.

Plasma endotoxin concentration and endotoxin binding capacity of plasma acute phase proteins in cirrhotics with variceal bleeding: an analysis by new methods

Plasma endotoxin levels in 12 cirrhotics with bleeding from oesophageal varices and 50 cirrhotics without bleeding were measured by the chromogenic assay after the pretreatment of sample by perchloric acid (HClO4) and triethylamine. Endotoxin in cirrhotics with bleeding from varices was significantly higher than those without bleeding. In patients with bleeding, endotoxin increased for 3 days after the bleeding, first in the supernatant fraction and then in the precipitate fraction by HClO4 treatment. Peak plasma alpha 1-acid glycoprotein and haptoglobin were observed 3 days after the bleeding. Alpha 1-antitrypsin gradually increased for 14 days. Transferrin did not markedly change. The endotoxin-binding capacity of transferrin and alpha 1-acid glycoprotein increased immediately after bleeding and thereafter decreased, but that of alpha 1-antitrypsin tended to increase in the recovery period. In summary, the plasma endotoxin concentration and endotoxin-binding capacity of alpha 1-acid glycoprotein and transferrin were shown to have increased after bleeding from varices by this new method. There may be a close relationship between endotoxaemia and acute phase reaction in this situation.

Measurement of fetal urine production in mild infantile polycystic kidney disease--a case report

It is generally recognized that the sonographic findings of infantile polycystic kidney disease (IPKD) are bilaterally enlarged kidneys, oligohydramnios, an absent fetal bladder, and the typical kidney texture. Since there is a broad spectrum of renal compromise with IPKD, in utero diagnosis is thought to be limited to the severe forms. This paper reports a mild case of IPKD, where the in utero diagnosis was established by measuring fetal urine production and amniotic fluid volume serially during pregnancy, and by ultrasonographic examination of fetal kidneys.

Cloning of a Drosophila melanogaster homologue of the mouse type-I bone morphogenetic proteins-2/-4 receptor: a potential decapentaplegic receptor

The Drosophila melanogaster (Dm) decapentaplegic (dpp) gene product plays an essential role during several stages of Dm development. The DPP protein is a member of the transforming growth factor-beta (TGF-beta) superfamily and an orthologue of mammalian bone morphogenetic proteins (BMP-2 and -4). Recently, a cDNA clone encoding the mouse Ser/Thr kinase receptor specific for BMP-2/-4 (mTFR11) was isolated. Here, we describe the deduced primary structure, the cytogenetic position and expression pattern of the Dm homologue of mTFR11 (DTFR), a putative DPP receptor. The cytogenetic position of the Dm dtfr gene was mapped to 25D. DTFR has striking homology to mTFR11, especially in the cytoplasmic domain (approx. 63%), including a Ser + Gly-rich box that is characteristic of type-I receptors for the TGF-beta superfamily. Although the amino acid (aa) sequence of the extracellular domain is less conserved than that of the cytoplasmic domain, the extracellular domains of these two molecules were more homologous (approx. 27%) to each other than any other receptors for the TGF-beta superfamily. The spacing of Cys residues in the extracellular domain, which is considered crucial to ligand specificity, is highly conserved in these two receptors. During Dm embryonic development, its expression pattern changes in a dynamic fashion with high levels of expression in mesoderm and midgut, with some relation to dpp mutant phenotypes.

Effects of transfected complement regulatory proteins, MCP, DAF, and MCP/DAE hybrid, on complement-mediated swine endothelial cell lysis

We established several swine endothelial cell (SEC) lines, expressing human MCP (CD46), DAF (CD55), and MCP/DAF hybrid by transfection of cDNA, and assessed the function of these transfectant molecules on complement-mediated cell lysis as an in vitro hyperacute rejection model of swine to human discordant xenograft. Discordant organ xenografts are hyperacutely rejected by complement activation. Amelioration of complement-mediated lysis by these transfectant molecules was tested in each SEC line by lactate dehydrogenase assay. Naive swine endothelial cells were markedly damaged by human complement mainly via the classical pathway, activating only minimally the alternative pathway of human complement. Both MCP and DAF protected SEC from human complement attack in parallel with the expression density, with DAF being more effective than MCP. The MCP/DAF hybrid was more effective than MCP alone, and as effective as DAF in this system. The results suggest that the transfection of DAF or the MCP/DAF hybrid cDNA into organs to be transplanted could protect against hyperacute rejection.

Efficacy of inactivated vaccine in preventing antigenically drifted influenza type A and well-matched type B

OBJECTIVE

To evaluate the efficacy of currently used inactivated influenza vaccine during a severe epidemic caused by antigenically drifted influenza type A(H3N2) and well-matched type B viruses during the 1992-1993 season.

DESIGN

Prospective nonrandomized controlled trial.

SETTING

An urban general hospital pediatric asthma clinic in Japan.

PARTICIPANTS

A total of 137 children with moderate to severe asthma (mean age, 7.0 years; range, 2 to 14 years).

INTERVENTION

Eighty-five children received trivalent split-antigen vaccine containing A/Beijing/352/89 (H3N2) and B/Bangkok/163/90 (B/Panama/45/90-like strain). Fifty-two were unvaccinated.

MAIN OUTCOME MEASURES

Protection against infection was determined using hemagglutination inhibition test and virus isolation. Clinical efficacy was estimated based on febrile episodes with antibody rise or virus isolation.

RESULTS

Although marked antigenic drift in hemagglutinin was demonstrated in the epidemic virus (A/Beijing/32/92-like strain), the protection against influenza type A(H3N2) infection was 67.5% (P < .01). The protection against influenza type B infection was 43.7% (P < .01), although the epidemic influenza type B viruses were antigenically almost identical to the vaccine strain. Inactivated vaccine was not effective for protection against influenza type B infection in children younger than 7 years. High clinical effectiveness was demonstrated in children at least 7 years of age during the epidemic.

CONCLUSIONS

Our data suggest that current inactivated vaccine is highly effective for protection against influenza type A(H3N2) virus infection regardless of antigenic drift. In contrast, the protective efficacy obtained by vaccination may not be sufficient against influenza type B virus infection, and especially in young children, it does not offer protection.

Endothelial modulation of vascular tone in isolated porcine and bovine basilar arteries

Endothelium-dependent modulation of vascular tone was investigated in isolated porcine and bovine basilar arteries. L-Nitro-arginine (NO synthase inhibitor) and methylene blue (soluble guanylate cyclase inhibitor) increased, but indomethacin (cyclooxygenase inhibitor) decreased the vascular tone in the basilar arteries from both species. Bradykinin evoked relaxation of precontracted porcine basilar artery, but not bovine basilar artery. Sodium fluoride (endothelial G-protein activator) produced relaxation of precontracted basilar arteries from both species. The effects of bradykinin and sodium fluoride were completely abolished by endothelial denudation and markedly inhibited by L-nitro-arginine and methylene blue, but not by indomethacin. Sodium nitroprusside (guanylate cyclase activator) evoked relaxation of precontracted endothelium-denuded basilar arteries from both species. These results suggest that there is species variation in endothelium-dependent modulation of vascular tone in the basilar artery.

[Complete eradication by endoscopic injection sclerotherapy reduces the recurrence of esophageal varices]

Endoscopic intravariceal injection sclerotherapy (EIS) using sclerosant mixed with contrast medium was done in 100 patients without hepatocellular carcinoma. They were followed longer than 12 months (mean; 58 +/- 29 months) after EIS. The recurrence rate of esophageal varices in cases with complete eradication (n = 79) and cases with incomplete eradication of (n = 21) was 8.9% and 85.7%, respectively (p < 0.01). In 21 cases, complete eradication was achieved by intravariceal injection and additional therapy using paravariceal injection was not performed. The recurrence rate of this group was only 4.8%. Endoscopic varicealography during injection sclerotherapy were evaluated in 91 cases. At final session of EIS, narrowing of diameter (less than 1 mm) and irregularity of vessel walls were observed in small vessels (devastated vessels). Appearance rate of devastated vessel in 75 cases with completely eradicated esophageal varices was 65.3%. In contrast, among 16 cases with incomplete eradication of varices, devastated vessels were seen only in 6.3% (p < 0.01). It is concluded that the important point in preventing the recurrence of esophageal varices after EIS was the complete eradication of esophageal varices by intravariceal injection sclerotherapy resulting in the eradication of the routes to esophageal varices from port-splenic venous system. For the sake of accomplishment of this treatment, appearance of devastated vessel is very useful.

Effects of misestimated far-end boundary values on two common lidar inversion solutions

Solutions of the lidar equation in both the Klett [Appl. Opt. 20, 211 (1981)] and the Fernald [Appl. Opt. 23, 652 (1984)] approaches include the effect of errors in the estimated boundary value at the far end. In the present study an attempt is made to formulate the effect of the error in the boundary value on the solution of the lidar equation. Using a modified extinction coefficient, we can simplify and unify the error expression of the lidar inversion solution. From the unified error expression and numerical experiments, we found that (a) in the case of overestimation of the boundary value, the discrepancy between the estimated value and the real value decreases near the lidar more rapidly than in the case of underestimation; and (b) the error for the Fernald solution converges to zero more rapidly than the error for the Klett solution, but the convergence of the Fernald solution sometimes shows oscillatory behavior, whereas the convergence of the Klett solution is always monotonic.

[Intraarterial infusion combination therapy with LV and 5-FU in hepatic metastases from colorectal cancer]

Intraarterial infusion combination therapy with LV and 5-FU was performed on 8 patients with hepatic metastases from colorectal cancer. Briefly, immediately after administration of LV 30 mg/body, 5-FU was administrated in doses of 750 to 1,250 mg/body over about 2 hours. The therapy was repeated at every weekly visit to the clinic. The number of courses per patient averaged 22. The response rate was 50% (4 PR). Clinical responses were obtained 6 months on average. The 50% survival period was 300 days. Five patients died, 3 due to metastases to other sites. This therapy on an out-patient basis could be continued in all but one patient who was withdrawn from the treatment because of leucopenia. The results of this study suggest that this combination therapy is effective for hepatic metastasis from colorectal cancer.

Acetylcholine measurement of cerebrospinal fluid by in vivo microdialysis in freely moving rats

Acetylcholine (ACh) and choline (Ch) levels in rat cerebrospinal fluid (CSF) were determined by in vivo microdialysis (CSF microdialysis) in both halothane-anesthetized and freely-moving rats. The Ch/ACh ratio in CSF perfused with Ringer's solution (30 microliters/30 min) containing 10(-5) M physostigmine, a centrally active cholinesterase inhibitor, was significantly lower than that in unprocessed CSF due to significantly higher ACh levels in the former. The successive measurement on the 2nd and 7th day after the guide cannula implantation demonstrated the feasibility of the CSF microdialysis method for repetitive monitoring of CSF ACh and Ch levels in freely moving rats without extensive tissue damage. Intraperitoneal administration of physostigmine caused an increase in CSF ACh levels, whereas administration of neostigmine, which cannot penetrate into the blood brain barrier, did not. Furthermore, a centrally active acetylcholinergic M1-receptor agonist, AF102B, produced an increase in CSF ACh and Ch levels. Thus, the present study demonstrates that CSF microdialysis is a useful method for evaluating overall central cholinergic activity and investigating the pharmacological effects of various drugs that act via the central cholinergic system.

Mechanisms of stimulatory effect of neuromedin C on pancreatic exocrine secretion in conscious rats

The mechanisms of the stimulatory effect of the bombesin-like peptide neuromedin C on pancreatic exocrine secretion were examined in conscious rats. Rats were prepared with cannulae draining bile and pancreatic juice separately. Intravenous infusion of 0.35 nmol/kg/h of neuromedin C significantly increased the secretions of pancreatic bicarbonate and protein, and transiently increased the plasma cholecystokinin (CCK) concentration. The increase in pancreatic secretion persisted for 90 min, whereas the increase in plasma CCK was observed only after 15 and 30 min from the beginning of neuromedin C infusion. Intravenous infusion of CR-1409, a specific CCK-receptor antagonist, inhibited, but did not abolish, the protein secretion stimulated by neuromedin C. Intraduodenal infusion of a potent proton pump inhibitor, omeprazole, suppressed, but did not abolish, protein secretion induced by neuromedin C. Omeprazole abolished the increase in bicarbonate secretion produced by neuromedin C. These results indicate that neuromedin C induces release of CCK and that its induction of pancreatic hypersecretion is due to both its direct effect and CCK. The results also suggest that gastric hypersecretion may have a role in the bicarbonate hypersecretion induced by neuromedin C.

Estimation of mitral valve area in patients with mitral stenosis by the flow convergence region method: selection of aliasing velocity

OBJECTIVES

We attempted to determine the most suitable aliasing velocity for applying the hemispheric flow convergence equation to calculate the mitral valve area in mitral stenosis using a continuity equation.

BACKGROUND

The flow convergence region method has been used for calculating mitral valve area in patients with mitral stenosis. However, the effect of varying aliasing velocity on the accuracy of this method has not been investigated fully.

METHODS

We studied 42 patients with mitral stenosis using imaging and Doppler echocardiography. Aliasing velocities of 17, 21, 28, 34, 40 and 45 cm/s were used. The transmitral maximal flow rate (Q [ml/s]) was calculated using the hemispheric flow convergence equation Q = 2 x pi x R2 x AV x alpha/180, where R (cm) is the maximal radius of the flow convergence region, AV is the aliasing velocity, and alpha/180 is a factor accounting for the inflow angle (alpha). Mitral valve area (A [cm2]) was calculated according to the continuity equation A = Q/V, where V (cm/s) is the peak transmitral velocity by the continuous wave Doppler method.

RESULTS

Mitral valve area was progressively underestimated with increasing aliasing velocity. The actual and percent differences noted between the mitral valve area by the flow convergence region method and that by two-dimensional echocardiographic planimetry were -0.06 +/- 0.23 cm2 (mean +/- SD) and 0.09 +/- 15.7% at an aliasing velocity of 21 cm/s, increasing gradually with increasing aliasing velocity, and were -1.24 +/- 0.9 cm2 and -72.56 +/- 16.4% at an aliasing velocity of 45 cm/s. Mitral valve areas estimated by the flow convergence region method at an aliasing velocity of 21 cm/s in 11 patients with associated > 2+ mitral regurgitation (2.12 +/- 1.17 cm2) and 8 with associated > 2+ aortic regurgitation (1.28 +/- 0.71 cm2) were not significantly different using planimetry (2.24 +/- 1.39 cm2, p > 0.05 and 1.27 +/- 0.74 cm2, p > 0.05, respectively) but were significantly different by the pressure half-time method (1.59 +/- 1.12 cm2, p < 0.001 and 1.63 +/- 0.93 cm2, p < 0.01, respectively).

CONCLUSIONS

This study indicated the most appropriate aliasing velocity for the accurate estimation of mitral valve area in patients with mitral stenosis.

Evaluation of cerebral vasoreactivity by three-dimensional time-of-flight magnetic resonance angiography

BACKGROUND AND PURPOSE

Cerebral vasoreactivity is an important indicator of the reserve capacity of the cerebral circulation. To make a quantitative analysis of cerebral vasoreactivity in individual major arterial territories, we evaluated the response to acetazolamide using three-dimensional time-of-flight magnetic resonance angiography.

METHODS

We examined 10 healthy volunteers and 6 patients with unilateral stenosis of the middle cerebral artery by a 1.5-T superconducting magnetic resonance imaging system. After a baseline vascular image was obtained, each subject received 17 mg/kg IV of acetazolamide; a second scan was performed 20 minutes later. Using a generally available personal computer and image analysis software, we measured the areas of the individual major arteries on collapsed axial vascular images and then calculated the vasoreactivity.

RESULTS

The average vasoreactivity of individual major cerebral arterial territories in the healthy volunteers was as follows: anterior cerebral artery complex, 33%; right middle cerebral artery, 71%; left middle cerebral artery, 74%; right posterior cerebral artery, 68%; and left posterior cerebral artery, 68%. In the patient group, the vasoreactivity of the stenotic middle cerebral arteries was significantly smaller than that of the nonstenotic arteries (P < .05). In addition, the nonstenotic middle cerebral arteries showed significantly less vasoreactivity than the right arteries of the healthy volunteers (P < .01).

CONCLUSIONS

Three-dimensional time-of-flight magnetic resonance angiography can be used to quantitatively evaluate acetazolamide-induced vasoreactivity in individual major cerebral arterial territories.

Calcium regulating activity of 26,27-dimethyl analog of 24R,25-dihydroxyvitamin D3

To determine the possibility that methyl substitution in 26- and 27-positions of 24R,25-dihydroxyvitamin D3 [24,25(OH)2D3] alters activities of the original compound, the effects of 24,25(OH)2D3 on calcium (Ca) regulating activity were compared with those of its methyl analog [24,25(OH)2(CH3)2D3] in addition to 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3]. 24,25(OH)2D3 at 10(-6) M and 24,25(OH)2(CH3)2D3 at 10(-7) M and above significantly stimulated both bone resorption in neonatal mouse calvaria cultures and formation of osteoclast-like multinucleated cells (MNC) in mouse bone marrow cultures. A stimulative effect of 1,25(OH)2D3 on bone resorption and MNC formation was recognized in very low concentrations (10(-11) M and above). Although a potency of 24,25(OH)2(CH3)2D3 in stimulating bone calcium (Ca) mobilization and intestinal Ca transport was higher than that of 24,25(OH)2D3, the potencies of both compounds were similar to that of 1,25(OH)2D3 unlike in vitro experiments. As 1,24R,25-trihydroxy-26,27-dimethylvitamin D3 showed almost the same effect as 24,25(OH)2(CH3)2D3, the dihydroxy form is suggested to be hydroxylated at 1 alpha position and converted to trihydroxy form in vitamin D-deficient rats. From these results, methyl substitution in 26- and 27-position of 24,25(OH)2D3 was found to elevate Ca regulating activity of the original compound. In addition, it is suggested that the basis for a similarity in potency between 1,25(OH)2D3 and 24,25(OH)2D3 or its dimethyl analog in vitamin D-deficient rats is likely the result of 1 alpha-hydroxylation.

[Nontraumatic subdural hematoma secondary to dural metastasis of lung cancer: case report and review of the literature]

In this paper, a case of nontraumatic subdural hematoma secondary to dural metastasis of lung cancer was presented and 43 cases in the literature were reviewed. A 75-year-old man who had been affected with lung tuberculosis for the previous 7 years was admitted to our hospital because of right hemiparesis and aphasia. No history of head injury was discovered. On admission, he was fully conscious and no other neurological abnormalities were noticed except for right hemiparesis and motor aphasia. The chest X-ray revealed abnormal shadows on the right lung, which were most suggestive of tuberculosis. Laboratory studies including prothrombin time, platelet count and fibrinogen were normal. The CT scans taken at that time demonstrated a large subdural hematoma over the left hemisphere. Under a diagnosis of chronic subdural hematoma, emergency evacuation through a small burr hole was performed. However, because of its low liquidity, the hematoma was insufficiently removed. Postoperatively, hemiparesis gradually disappeared. On the 20th hospital day, he suddenly became unconscious and CT scans showed recurrence of the subdural hematoma. Temporo-parietal craniotomy was immediately carried out. The dura was thickened and hyperemic. Although the underlying brain was apparently normal, the exploration performed after removal of the hematoma revealed a soft grayish mass extruding into the subdural space from the dura. The bleeding point was not identified. Both the dura and the abnormal tissue were biopsied for histological examination.(ABSTRACT TRUNCATED AT 250 WORDS)

High-level expression of Mycoplasma arginine deiminase in Escherichia coli and its efficient renaturation as an anti-tumor enzyme

The arginine deiminase (AD) gene was cloned from Mycoplasma arginini and expressed in the cytosol of Escherichia coli as inclusion bodies with an expression level of at least 20% of the total bacterial proteins. The inclusion bodies were solubilized with 6 M guanidine hydrochloride (Gdn-HCl) under reducing conditions, in order to avoid incorrect disulfide-bond formation of the recombinant (r-) AD molecules, and renaturation was performed under various refolding conditions. The optimum renaturation conditions were found to be incubation for 90 h at pH 7.5 and 15 degrees C. The resulting completely refolded r-AD was purified to homogeneity by anion-exchange and arginine-affinity chromatography and its activity yield was 72.5%. The specific activity of the purified r-AD was comparable to and its amino acid composition was identical to those of Mycoplasma AD, and NH2-terminal sequence analysis revealed that its methionine residue corresponding to the translation initiation codon had been removed completely. Anti-tumor activity analyses showed that r-AD inhibited the growth of two mouse cell lines, hepatoma MH134 and fibrosarcoma Meth A, strongly in vitro at concentrations in excess of 10 ng ml-1. Moreover, when MH134-implanted mice were given single intravenous injections of r-AD at doses of 50 mg kg-1 and higher, their survival times were prolonged significantly. These results, taken together, indicate that the enzymatic properties and biological actions of r-AD were highly consistent with those of Mycoplasma AD.