Morphological study of cationic polymer-anionic surfactant complex precipitated in solution during the dilution process

We investigated the phase diagrams and the morphology of the complexes that were formed by cationic polymers, cationic cellulose (CC) and cationic dextran (CD), and by anionic surfactant-based sodium poly(oxyethylene) lauryl ether sulfate (LES). The anionic charge of the LES-based surfactants was changed by adding an amphoteric surfactant, lauryl amidopropyl betaine acetate (LPB), or a nonionic surfactant, polyoxyethylene stearyl ether (C18EO25). We discuss the relationship between the complex aggregation process and the morphology of the precipitated complexes. The morphologies of CC complex aggregates, which precipitated during the dilution process in a model shampoo solution, changed from membranous forms to mesh-like forms by decreasing the charges of both the CC and the surfactant. Their touch on hair in the rinsing process changed from sticky to smooth and velvety, corresponding to their rheological properties. In contrast, CD complex aggregates had a membranous form and a smooth touch independently of the charges on the polymer and surfactant. These results suggested that the control of the charges of both the polymer and surfactant and the choice of polymer structure are important for excellent conditioning effects upon rinsing with shampoo.

Prediction of functional outcome in acute cerebral hemorrhage using diffusion tensor imaging at 3T: a prospective study

BACKGROUND AND PURPOSE

Early evaluation of the pyramidal tract is a prerequisite in patients with intracerebral hemorrhage (ICH) in order to decide the optimal treatment or to assess appropriate rehabilitation. The aim of this study was to evaluate and predict the neuromotor and functional outcome of an ICH by using diffusion tensor imaging (DTI) in the acute phase.

MATERIALS AND METHODS

Eighteen patients with a hemiparetic supratentorial ICH were prospectively studied with DTI within 2 days after onset. A region-of-interest-based analysis was performed for the fractional anisotropy (FA) of the pyramidal tract in the cerebral peduncles. The degree of paresis was assessed at day 0 and day 28 by paresis grading (PG). The functional outcome was evaluated by the modified Rankin Scale (mRS).

RESULTS

The FA in the affected side was significantly lower compared with that of the unaffected side (P = .001) with the mean diffusivity remaining unchanged (P = .50). The ratio of the FA (rFA) in the affected side to the unaffected side was significantly correlated with the PG at day 0 and 28 and the mRS score at day 28 (P = .002, r = -0.674; P < .001, r = -0.767; and P = .002, r = -0.676). The rFA for the good and poor outcomes based on the PG was significantly different (P < .001). The cutoff point of the rFA for the good and poor outcomes was set at 0.85 (sensitivity, 100%, specificity, 100%).

CONCLUSIONS

We conclude that DTI can evaluate the motor deficit quantitatively and may predict the functional outcome in patients with an ICH who were scanned within 2 days after the ICH onset.

Telecontrolled micromanipulator system (NeuRobot) for minimally invasive neurosurgery

BACKGROUND

To perform less invasive neurosurgery, a telecontrolled micromanipulator system has been developed and applied to clinical situations. Basic experiments for telesurgery have also been conducted.

METHOD

A cadaver head was used to carry out surgical simulation of the opening of the sylvian fissure and third ventriculostomy. After obtaining permission from the Ethical Committee of Shinshu University School of Medicine, part of the recurrent meningioma in a 45-year-old man was removed. As basic experiment for telesurgery, surgical simulation was also conducted in a rat brain with the operating console transported to a hospital 40 km distant from the University.

FINDINGS

Opening of the sylvian fissure and third ventriculostomy were accurately performed. Tumour removal in a patient with recurrent meningioma was safely achieved. Surgical simulation in the rat brain was accurately and correctly carried out, operated on from a hospital 40 km distant.

CONCLUSIONS

The NeuRobot, telecontrolled micromanipulator system, can be used as a tool for less invasive neurosurgery.

[Angina pectoris in patients who underwent stent implantations for severe atherosclerotic coronary lesions 16 years after heart transplantation]

The case was a 56-year-old male who underwent heart transplantation due to dilated cardiomyopathy abroad in 1990. In 2006, he suffered from anginal chest pain on effort. The coronary angiogram showed severe atherosclerotic lesions in the middle of left descending artery. A drug eluting stent, Cypher 3.5 x 23 mm was deployed, followed by balloon dilatations (4 x 8 mm). The procedure was successful without any complications. Furthermore, the 8-month follow-up angiogram showed no significant restenosis in the target vessel. There have been several reports on the outcomes of percutaneous coronary intervention (PCI) for cardiac allograft vasculopathy. According to them, the drug eluting stent, as is used in the present case, might be a promising procedure after further evaluations.

Glutathione-sensitive stabilization of block copolymer micelles composed of antisense DNA and thiolated poly(ethylene glycol)-block-poly(L-lysine): a potential carrier for systemic delivery of antisense DNA

Glutathione (GSH)-sensitive stabilization of polyion complex (PIC) micelles entrapping antisense oligonucleotide (ODN) was achieved by the reversible cross-linking of the core through disulfide bonds, aiming at the development of a novel DNA carrier system for antisense therapy following systemic administration. Thiolated poly(ethylene glycol)-block-poly(L-lysine) (PEG-thioPLL) and ODN spontaneously associated to form the PIC micelles with the core cross-linked through disulfide bonds. The diameters of the cross-linked micelles were similar to those of the non-cross-linked micelles and were determined to be about 40 nm by light scattering measurements. The micelles have sufficient colloidal stability due to the PEG shell surrounding the core of the polyion complex composed of PLL and ODN. The polyanion exchange studies suggested that the dissociation of the micelles was suppressed through the core cross-linking. The stability of the ODN in the core cross-linked micelles against nuclease was appreciably increased compared to that of free ODN and that in the micelles without cross-linking. On the other hand, the micelles dissociated to release ODN in the presence of GSH at a concentration comparable to the intracellular environment, featuring the potential ability of this system for intracellular ODN delivery.

Low anterior interhemispheric approach--a narrow corridor to aneurysms of the anterior communicating artery

BACKGROUND

Many approaches for clipping anterior communicating artery (ACoA) aneurysms are reported in the literature. We describe here a new approach called "low anterior interhemispheric approach" for clipping of ACoA aneurysms.

MATERIALS AND METHODS

A low anterior interhemispheric approach utilizing a unilateral frontal craniotomy flap with minimal unilateral frontal lobe retraction was used in treating four patients harboring an unruptured ACoA aneurysm. The approach axis is directed to the ACoA area itself with minimal exposure to the anterior cerebral vessels.

FINDINGS

In all patients, complete neck clipping was possible with minimal brain retraction, without vascular damage and preserved olfaction.

INTERPRETATION

This approach is preferred on anatomical grounds for cases of unruptured small and medium sized ACoA aneurysms projecting anteriorly or posteriorly because the anterior communicating artery complex area can be fully visualized with minimal manipulation of the frontal lobes and anterior cerebral arteries.

How to make a three-dimensional surgical illustration of cerebral vessels with a personal computer: technical note

OBJECTIVE

To introduce a method of making three-dimensional (3-D) illustrations of cerebral vessels with a personal computer.

METHODS

We generated the 3-D images from only two views of conventional angiograms (anteroposterior and lateral views) with a personal computer, two commercial software programs, and an image scanner.

RESULTS

This method was applied to 10 consecutive cases of cerebral aneurysms. 3-D images were made in a few hours, and they contributed to assessing vascular structures of an aneurysm complex.

CONCLUSION

This method is useful for discussing surgical strategies preoperatively. Our method may be used in any facility where conventional angiography, personal computers, and 3-D software are available.

[Surgical treatments for 7 pituitary adenomas in multiple endocrine neoplasia type 1]

We analyzed 7 pituitary adenomas in patients with multiple endocrine neoplasia type 1 (MEN1). Their incidence was 1.6% among 450 patients with pituitary adenomas which had been treated surgically in our department between 1978 and 1999. The age, gender, symptoms, type of hormone secretion, pathological and operative findings in the MEN1 patients were not apparently different from those in the non-MEN1 patients. Incidence of non-functioning pituitary adenomas, however, was more frequently encountered in our series than that in previous reports among Caucasian people. One patient who had 5 previous operations for the MEN tumors died following postoperative subarachnoid hemorrhage. Four of the seven patients presented initial symptoms related to pituitary adenomas and increased serum Ca level was retrospectively recognized in three of the four at the time of treatment for the pituitary adenomas.

Parameters for contralateral approach to ophthalmic segment aneurysms of the internal carotid artery

OBJECTIVE

This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA).

METHODS

Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram.

RESULTS

Parameters A to F were 8.8 mm (range, 5.4-11.1 mm), 14.5 mm (range, 10.4-22.2 mm), 0.9 mm (range, 0.6-1.3 mm), and 3.0 mm (range, 2.3-4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3-2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm.

CONCLUSION

Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.

Intentional body clipping of wide-necked basilar artery bifurcation aneurysms

OBJECT

Neck clipping or coil embolization cannot always achieve complete neck obstruction in wide-necked basilar artery (BA) bifurcation aneurysms. Clipping of the aneurysm body, leaving a small aneurysm rest, is one clipping method used for this kind of aneurysm to maintain the patency of the posterior cerebral arteries and perforating vessels. However, the long-term efficacy of intentional body clipping has not been well investigated. The authors reviewed their experience with intentional body clipping of wide-necked BA bifurcation aneurysms to determine suitable clipping techniques and the long-term efficacy of the procedure.

METHODS

Complete neck occlusion was abandoned and body clipping intentionally performed in 17 patients with BA bifurcation aneurysms; wrapping of the aneurysm rest was made in seven cases. There were 10 ruptured aneurysms (58.8%), and the size of the aneurysm was larger than 10 mm in 11 patients (64.7%). The width between the clip blades and the base of the aneurysm neck was 1 mm in 11 cases, 2 mm in four, and 3 mm in two. Favorable outcome (Glasgow Outcome Scale [GOS] Score 4 or 5) was obtained in 13 cases (76.5%) and unfavorable outcome (GOS Scores 1-3) in four cases (23.5%). Major causes of unfavorable outcome included injury to perforating arteries and major vessel occlusion following surgical manipulation, in addition to the primary damage caused by subarachnoid hemorrhage. Subarachnoid hemorrhage did not occur during a mean follow-up period of 7.4+/-5.6 years (range 0.7-18.1 years) after treatment.

CONCLUSIONS

Intentional body clipping of wide-necked BA aneurysms proved to be effective to prevent subarachnoid hemorrhage, although injury to perforating arteries remains problematic. The choice of complete neck clipping or body clipping should be established early during the microsurgical procedure to reduce the risk of injury to perforating vessels.

[Giant cell tumor originating in the sphenoid bone: a case report]

The authors report a case of giant cell tumor originating in the sphenoid bone. A 29-year-old woman presented with headache and diplopia. Bilateral ophthalmoplegia developed and MRI showed rapid growth of the tumor in spite of transnasal removal and conventional radiation therapy. The second transnasal surgery was performed 3 weeks after completion of radiotherapy. The symptoms were relieved except for right abducens palsy. Chemotherapy with cisplatin and etoposide was started after the second operation. The patient regained full ocular movement several months after the operation. Clinical remission has continued for four years. We conclude that the combination of repeated operations in the initial phase of rapid tumor growth, irradiation and chemotherapy is important to achieve tumor control.

[Clinical review of acute scrotum in children]

BACKGROUND

The acute scrotum in children frequently presents a diagnostic dilemma. The objective of this study is to review the experience of patients with acute scrotum in children.

METHODS

From April 1986 until March 1998, we encountered 40 cases of acute scrotum in children less than 15 years old diagnosed by surgical exploration.

RESULTS

Final diagnoses consisted of 14 patients with torsion of the spermatic cord (35%), 22 patients with torsion of the testicular appendage (55%), 3 patients with acute epididymitis (7.5%), and patient with a strangulated hernia (2.5%). Of 22 patients with torsion of the testicular appendage, which were the most frequent cause of acute scrotum, 20 had torsion of the testicular appendix and 2 had torsion of the epididymal appendix. The age distribution of the patients with torsion of the spermatic cord was biphasic, with the highest frequencies occurring in patients 2 years old and 14 years old. In contrast, the age distribution of patients with torsion of appendage showed a single peak incidence at 9 years of age. Those with epididymitis were younger than 2 years old. Of 14 cases of torsion of the spermatic cord, orchiectomy was performed in 6 cases (42.9%) because of testicular necrosis.

CONCLUSION

Although surgical exploration is no longer necessary for all patients with torsion of the appendage, this review revealed that patients complaining of severe or persistent pain usually require surgery to diagnose and treat the problem.

Primary chemotherapy for children with rhabdomyosarcoma of the 'special pelvic' sites: is preservation of the bladder possible?

Twenty-one children with rhabdomyosarcoma involving the "special pelvic" sites, defined as such occurring in the bladder, prostate, vagina and uterus, were treated with primary surgery between 1969 and 1977, and with primary chemotherapy beginning in 1978. Among 11 patients in the latter group who were placed in Clinical Group III (according to the classification of the US Intergroup Rhabdomyosarcoma Study (IRS), six showed partial response (PR) and underwent tumorectomy by radical surgery an average of 6 months after the start of treatment, and three showed complete response (CR) and were treated with further chemotherapy in the hope that cystectomy could be avoided. However, in the latter group, the tumor recurred (39 months, 35 months, and 27 months later), and all eventually underwent total cystectomy. Seven of the nine long-term survivors underwent total cystectomy and have premanent urinary-cutaneous stomas. Two had tumor-free bladders, but function was impaired in one because of the effect of irradiation. Normal function was preserved in only one patient in the series, whose tumor was located at the dome of the bladder. To preserve bladder function in children with rhabdomyosarcoma in these sites, more effective forms of chemotherapy will be required.

Intragenic homozygous deletion of the WT1 gene in Wilms' tumor

One example of intragenic homozygous deletion of the WT1 gene on chromosome 11p13 was found after screening 42 samples of Wilms' tumor DNA from Japanese patients. After construction of a restriction map for the genomic sequence covering the 3' half of the gene, the deletion was analysed at the nucleotide sequence level. The deletion occurred in the patient's germline on his paternal chromosome, and most of the short arm of his maternal chromosome 11 was subsequently lost in the tumor. The size of the deletion was about 8 kb, removing exons 6 and 7 and resulting in premature termination. The deletion seemed to be created by recombination between short homologous sequences found in an Alu repeat, with a 16-bp duplication left at the junction. This case conforms to a two-hit model for the genesis of a certain group of tumors, and supports the hypothesis that WT1 is one of the recessive oncogenes responsible for Wilms' tumor.

Deoxyribonucleic acid and cytological detection of Y-containing cells in an XX hypospadiac boy with polyorchidism

A hypospadiac boy with a hypoplastic penis and an apparent 46,XX karyotype in blood and testis cultures is described. Exploratory laparotomy and bilateral gonadal biopsy revealed the presence of 2 testes in the right and 1 in the left hemiscrotum, each of which only showed hypoplastic testicular tissues histologically. Uncultured testis smears showed Y chromatin in approximately 20% of the cells. Also, the Southern blot and polymerase chain reaction analyses detected a weak but distinct signal of Y chromosome-derived deoxyribonucleic acid sequences in the perineal skin but not in the blood lymphocytes. The results indicated that the boy had a small proportion of Y chromosome-containing cells in the form of mosaicism in limited tissues, such as the testes and perineal skin. This finding may have implications in the genesis of testes in some cases of XX patients, and true hermaphrodites or male pseudohermaphrodites with an apparent 46,XX karyotype. To our knowledge, this appears to be the first case of polyorchidism with an identified chromosome abnormality.

[A case of true phimosis with bilateral hydroureteronephrosis and bilateral vesicoureteral reflux]

A 12-year-old boy presented with nocturnal enuresis. He could not void in a stream and urine dropped out of the external urethral orifice. Physical examination revealed the stenosis of prepuce and balanoposthitis. An intravenous pyelogram and a cystogram showed bilateral hydroureteronephrosis and bilateral vesicoureteral reflux. He was diagnosed with severe true phimosis complicated with bilateral hydroureteronephrosis and bilateral vesicoureteral reflux. His balanopothitis was treated with antibiotics for a few days. Dorsal slit of prepuce and release of adhesion between glans and prepuce were subsequently performed. Four months after operation, an intravenous pyelogram revealed regression of hydronephrosis. Bilateral vesicoureteral reflux was not observed on the cystogram. The possibility of upper urinary tract involvement must be considered in patients with true phimosis and dysuria.

[Bone metastasis of malignant solid tumors in childhood]

A total of 452 cases of childhood malignant solid tumors were treated over the last twenty years at the National Children's Hospital. These included 175 cases of neuroblastoma, 64 cases of Wilms' tumor, 65 cases of malignant lymphoma, 45 cases of soft tissue sarcoma, 31 cases of hepatoma, 20 cases of malignant teratoma, 17 cases of testicular tumor, 7 cases of ovarian tumor and 28 cases of other forms of malignant solid tumor. Bone metastasis was observed in 62 of 175 cases of neuroblastoma, 3 of 64 cases of Wilms' tumor, one of 65 cases of malignant lymphoma, 4 of 45 cases of soft tissue sarcoma, one case of pulmonary blastoma and one case of osteogenic sarcoma, giving a total occurrence of bone metastasis in 72 of the 452 cases. The main sites of bone metastasis in neuroblastoma were the skull (61.4%), femur (56.8%), orbit (27.3%) and spine (22.7%). The average values of serum calcium and alkaline phosphatase activity showed no significant difference. The patients with bone metastasis were treated with a combination of radiation therapy and intensive chemotherapy, resulting in temporary improvement. The survival of patients with stage IV neuroblastoma with bone metastasis was worse than that of similar patients without bone metastasis.