Factors associated with perioperative deep vein thrombosis in arthroscopic anterior cruciate ligament reconstruction

BACKGROUND

Anterior cruciate ligament reconstruction (ACLR) is reportedly associated with a higher incidence of deep vein thrombosis (DVT) incidence than other arthroscopic surgical procedures. The aim of this study is to retrospectively investigate the incidence and type of DVT and evaluate the relationship between DVT and risk factors among all patients who underwent ACLR under uniform conditions consisting of mechanical prophylaxis, no medical prophylaxis, and preoperative and postoperative lower extremity venous ultrasonography.

METHODS

Of the 114 patients who underwent arthroscopic primary ACLR at our hospital who did not have a compound ligament injury or revision surgery, 112 patients were included. Two patients were not examined. DVT evaluation consisted of whole-leg ultrasonography at 1 week after surgery. We evaluated age, sex, body mass index, comorbidities, operative time, tourniquet time, presence of concurrent surgery (meniscus repair/resection or osteochondral column grafting), and non-weight-bearing status at 1 week after surgery as risk factors for DVT.

RESULTS

DVT was found in 33 (29.5%) of 112 patients. Of these, 22 (19.6%) had distal DVT and 11 (9.8%) had proximal DVT. Non-weight-bearing status at 1 week after surgery was a statistically significant risk factor for proximal DVT (P = .034).

CONCLUSIONS

Non-weight-bearing status is an independent risk factor for DVT, suggesting that early weight bearing may reduce the occurrence of DVT.

Targeting FoxO transcription factors with HDAC inhibitors for the treatment of osteoarthritis

OBJECTIVES

Osteoarthritis (OA) features ageing-related defects in cellular homeostasis mechanisms in articular cartilage. These defects are associated with suppression of forkhead box O (FoxO) transcription factors. FoxO1 or FoxO3 deficient mice show early onset OA while FoxO1 protects against oxidative stress in chondrocytes and promotes expression of autophagy genes and the essential joint lubricant proteoglycan 4 (PRG4). The objective of this study was to identify small molecules that can increase FoxO1 expression.

METHODS

We constructed a reporter cell line with FoxO1 promoter sequences and performed high-throughput screening (HTS) of the Repurposing, Focused Rescue and Accelerated Medchem (ReFRAME) library . Hits from the HTS were validated and function was assessed in human chondrocytes, meniscus cells and synoviocytes and following administration to mice. The most promising hit, the histone deacetylase inhibitor (HDACI) panobinostat was tested in a murine OA model.

RESULTS

Among the top hits were HDACI and testing in human chondrocytes, meniscus cells and synoviocytes showed that panobinostat was the most promising compound as it increased the expression of autophagy genes and PRG4 while suppressing the basal and IL-1β induced expression of inflammatory mediators and extracellular matrix degrading enzymes. Intraperitoneal administration of panobinostat also suppressed the expression of mediators of OA pathogenesis induced by intra-articular injection of IL-1β. In a murine OA model, panobinostat reduced the severity of histological changes in cartilage, synovium and subchondral bone and improved pain behaviours.

CONCLUSION

Panobinostat has a clinically relevant activity profile and is a candidate for OA symptom and structure modification.

A Simple Method to Reduce the Incidence of Cyclops Lesion after Anterior Cruciate Ligament Reconstruction

The purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel debridement was not performed. Postoperative MRI was performed to evaluate the presence of CL and the following three criteria: (1) the intercondylar site of CL (grade 1-3), depending on its anterior extent along the femoral condyle; (2) posterior bowing of the ACL graft; and (3) the positional relationship between the frontmost fiber of ACL graft and Blumensaat's line. If CL caused loss of extension or pain or discomfort during knee extension, it was defined as symptomatic CL (SCL). CL was detected in 8 cases (21.1%) in Group A and 26 cases (46.4%) in Group B. The prevalence of CL was significantly lower in Group A than in Group B (p = 0.010), and the risk ratio of CL was 0.31 (95% confidence interval: 0.12-0.79). Furthermore, 10 patients in Group B had SCL, compared with none in Group A (p = 0.004). In Group A, the intercondylar site of CL was grade 1 in all cases, while in Group B, the CL grades were 1 (n = 17), 2 (n = 7), 3 (n = 2) (p = 0.008). There were no cases of posterior bowing of the ACL in Group A, but six cases in Group B (p = 0.023). Debridement in and around the bone tunnel is a simple and effective method of preventing CL and SCL after ACLR. The level of evidence for the study is 3.

Thermal damage of osteocytes during pig bone drilling: an in vivo comparative study of currently available and modified drills

OBJECTIVES

The Gekkou-drill® is an industrial drill that is highly efficient due to reduced cutting resistance resulting from its characteristic drill point shape. In this experiment, we compared the degree of thermal damage to bone tissue caused by conventional medical drills and these same drills with Gekkou modifications.

METHODS

Holes were created in the tibias of living pigs using two different 3.2-mm diameter drills and their modified versions. Regarding the drilling parameters, the thrust force was 10 N and the drilling speeds were 800 revolutions per minute (rpm) and 1500 rpm. We compared the original and modified drills in terms of the bone temperature around the drill bit and the total time necessary to create each hole, the latter calculated using imaging data captured during drilling. In histopathological examination, the percentages of empty lacunae in osteocytes of the cortical bone beneath the periosteum were evaluated at 400 × magnification with an optical microscope.

RESULTS

Compared to the original drills, the modified drills required significantly less time to create each hole and caused a significantly lower temperature rise during bone drilling. With the modified drills, the percentages of empty lacunae around the drilling holes were about 1/2-1/3 of those with the original drills, and were significantly lower for both drilling speeds.

CONCLUSIONS

Gekkou-modified medical drills shortened drilling times despite low thrust force, and histopathological assessment demonstrated a significant reduction in osteocyte damage.

Conservative treatment for lumbar compartment syndrome shows efficacy over 2-year follow-up: a case report and literature review

BACKGROUND

Since in all studies of conservative treatment of lumbar compartment syndrome the follow-up duration was less than 6 months, it is difficult to draw firm conclusions.

PURPOSE

To report a patient with lumbar paraspinal compartment syndrome who was treated conservatively over a follow-up period of 2 years.

STUDY DESIGN

This is a case report of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively.

METHODS

We report a case of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. We repeatedly checked his physical examination, laboratory tests, lumbar compartment pressures, and magnetic resonance imaging, and surgical teams were readily prepared to operate should the patient's condition worsen. To prevent complications of rhabdomyolysis, hydration and alkalization were performed. We followed him up to 2 years after discharge.

RESULT

Although the temporal changes on MRI up to the 1-year point, the patient continued to have no symptoms.

CONCLUSIONS

Conservative therapy can be recommended if rhabdomyolysis is under control.

Impact of Severe Coronary Disease Associated or Not Associated with Diabetes Mellitus on Outcome of Interventional Treatment Using Stents: Results from HERZ (Heart Research Group of Kanazawa) Analyses

Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) leads to less re-stenosis than PCI using a bare metal stent (BMS), however there is still controversy whether use of a DES for severe coronary disease leads to an acceptable outcome in patients with diabetes mellitus (DM). In this study 8159 lesions were treated in 6739 patients (mean age 68.9 years) with coronary artery disease. Use of a DES significantly decreased the re-stenosis rate compared with BMS in both DM (9.6% versus 21.3%) and non-DM (9.5% versus 17.1%) patients. The re-stenosis rate was significantly higher in DM than in non-DM patients in the BMS group but not in the DES group. There was no statistically significant difference in event-free survival after stenting of patients with left main coronary artery (LMCA) disease between the BMS and DES groups. It was concluded that, compared with BMS, DES reduced re-stenosis in patients with DM, however, we advise careful treatment after using DES for severe coronary disease, including LMCA lesions, in patients with DM.

Combination chemotherapy using carboplatin (JM-8) and etoposide (JET therapy) for recurrent malignant gliomas: a phase II study

BACKGROUND

To study efficacy and safety of chemotherapy using carboplatin (JM-8) and etoposide ("JET" therapy) for the treatment of recurrent malignant glioma, a phase II study was conducted. Tumour control, survival time, and toxicity/side effects were assessed in patients with recurrent malignant glioma which failed to respond to a postoperative combined auxiliary therapy comprising of IFN-beta, ACNU and radiation.

METHODS

Twenty-eight patients, fourteen with anaplastic astrocytoma (AA) and fourteen with glioblastoma (GB) were included in this study. The JET regimen consists of the intravenous administration of carboplatin (300 mg/m(2)) on day 1 and etoposide (60 mg/m(2)) on day 1 to 5, repeated every 6 weeks.

FINDINGS

Following the therapy, we observed partial response (PR) in five (36%) of 14 patients with AA and two (14%) of 14 with GB, and stabilization of the disease (SD) in six (43%) in each group. The mean survival/survival after recurrence was 51 months/25 months in the AA group, and 17/9 in the GB group.

INTERPRETATIONS

These results compare favorably with the natural course of recurrent malignant glioma. JET shows signs of efficacy in patients with recurrent malignant glioma, and a randomized trial comparing it to standard therapy is warranted.

Right ventricular metastasis from a primary cervical carcinoma

A 49-year-old female presented with a 1-month history of cough and low-grade fever. Echocardiography showed a large mass in the right ventricle and percutaneous right ventricular endomyocardial biopsy provided the histologic diagnosis. Despite radiotherapy and chemotherapy, the patient died. At autopsy, the metastatic deposit in the heart was larger than the primary cervical carcinoma.

[Changes in serum malondialdehyde-modified low-density lipoprotein in patients with acute myocardial infarction and stable angina pectoris treated by coronary angioplasty]

OBJECTIVES

Serum malondialdehyde-modified low-density lipoprotein(MDA-LDL) was measured as a marker of oxidative stress, and the changes in serum MDA-LDL compared in patients with acute myocardial infarction and stable angina pectoris treated by percutaneous transluminal coronary angioplasty (PTCA).

METHODS

Forty-one patients with acute myocardial infarction or stable angina pectoris were admitted to our hospitals between January 2000 and June 2000. Direct PTCA was performed in 17 patients(MI group) and elective PTCA in 24 patients(AP group). Coronary angiography was performed in nine control subjects(control group). Serum MDA-LDL was measured in the peripheral venous blood before and immediately after procedures in each group(normal range 20-80 U/l).

RESULTS

There were no significant differences in patient characteristics, except age, between the MI group and AP group. Serum MDA-LDL was elevated above the normal range before the procedure in both groups(MI group 104.7 +/- 52.0 U/l, AP group 99.7 +/- 42.8 U/l), and significantly decreased immediately after the procedure(MI group 61.3 +/- 25.6 U/l, AP group 62.0 +/- 29.6 U/l), but there were no significant differences between the two groups. Serum MDA-LDL was elevated before the procedure (99.3 +/- 48.9 U/l) in the control group and significantly decreased immediately after the procedure(61.7 +/- 26.2 U/l). However, these values did not differ from the values before and immediately after the procedure in the MI group and the AP group. The percentage changes in serum MDA-LDL before and immediately after the procedure were -38 +/- 16% in the MI group, -37 +/- 17% in the AP group and -36 +/- 20% in the control group, and there were no significant differences between the three groups.

CONCLUSIONS

No significant difference in the changes in serum MDA-LDL was observed between patients with acute myocardial infarction and stable angina pectoris treated by PTCA. However, anticoagulants may affect the MDA-LDL measurements directly, because similar changes in serum MDA-LDL were observed in control subjects after only coronary angiography.

Acute inferior myocardial infarction and coronary spasm in a patient with an anomalous origin of the right coronary artery from the left sinus of valsalva

A 56-year-old Japanese woman with an acute inferior myocardial infarction was admitted to hospital. Emergency coronary angiography revealed an anomalous origin of the right coronary artery from the left sinus of Valsalva, but there was no stenosis or thrombus in either the right or left coronary artery. Coronary spasm was provoked at the site of the proximal portion of the anomalous coronary artery, which was located between the aorta and pulmonary trunk. This was thought to be the cause of the myocardial infarction.

Generation of tumor-specific T-lymphocytes by cross-priming with human dendritic cells ingesting apoptotic tumor cells

It has been suggested that dendritic cells (DCs) are capable of ingesting apoptotic tumor cells (ATCs) and presenting tumor-associated antigens to immune cells. We evaluated the potential of human DCs, which have ingested ATCs, to serve as a source of antigenic epitopes for presentation to T cells specific for PCI-13, a squamous cell carcinoma of the head and neck cell line. Immature DCs (DCimm) generated in the presence of interleukin 4 and granulocyte machrophage colony-stimulating factor from peripheral blood monocytes of HLA-A2+ healthy donors were incubated in the presence of ATCs. Uptake of ATCs by DCs was monitored by flow cytometry and confocal microscopy after 2-18 h of coincubation. When DCs were matured (DCmat) in the presence of proinflammatory cytokines, their capacity to uptake ATCs was reduced. Responses of PCI-13-specific CD8+ T cells to unmodified PCI-13 cells and to DCimm or DCmat +/- ATCs or +/- tumor lysates were tested in gamma-IFN enzyme-linked immunospot and cytotoxicity assays. Unmodified tumor cells were found to be the best stimulators of antitumor activity of the established T-cell line, and ATCs alone were minimally stimulatory. However, DCs that ingested ATCs were able to present tumor antigens to CTLs, and DCimm and DCmat were almost equally stimulatory. When DCs plus various tumor-derived preparations were used as antigen-presenting cells with autologous HLA-A2+ T cells obtained from normal donors, DCs that had ingested ATCs were more effective in generating CD8+ CTLs than tumor cells alone or DCs pulsed with tumor lysates. The results indicate that human DCs fed with ATCs and then matured effectively generated T cell-mediated antitumor responses in vitro.

Urinary output changes in racemic ethylamphetamine and optical activity discrimination in rat urine by HPLC analysis

Characterization of optical activity and simultaneous analysis of racemic ethylamphetamine (EAMP) and its metabolites, as well as the urinary excretion of the optical isomers, were examined in rats by high-performance liquid chromatography (HPLC). Analysis of the optical isomers of EAMP, amphetamine (AMP), para-hydroxy-ethylamphetamine (p-OH-EAMP), and para-hydroxy-amphetamine (p-OH-AMP) was performed within 90 min. The limit of detection was 30 ng for EAMP and AMP, and 60 ng for p-OH-EAMP and p-OH-AMP per 20 microliters injection. After oral administration of racemic EAMP, rat urine specimens were collected at four intervals, 0-4, 4-12, 12-20 and 20-24 h. After administration of 30 mg/kg EAMP, not only each isomer of EAMP, i.e. AMP, p-OH-EAMP and p-OH-AMP, but also an unidentified substance (UI) were detected. The UI was presumed to be 3-hydroxy-4-methoxy-N-EAMP or 3-methoxy-4-hydroxy-N-EAMP by gas chromatographic mass spectrometry (GC-MS) analysis. The d-isomer of EAMP was generally excreted more abundantly than the l-isomer (p < 0.01-0.05). The d-isomer of AMP and p-OH-EAMP was excreted in the first 4 h in a somewhat smaller amount than the l-isomer but thereafter in a greater amount than the l-isomer. The d-isomer of p-OH-AMP was generally excreted in a smaller amount than the l-isomer (p < 0.1-0.05). The total percentages of the dose excreted up to 24 h were 2.65% of the dose of EAMP administered [d: 2.04% and l: 0.61%], AMP 3.15% [d: 1.68% and l: 1.47%], p-OH-EAMP 63.06% [d: 32.68% and l: 30.38%], and p-OH-AMP 2.57% [d: 1.05% and l: 1.52%]. The optical purity ratio (l/d) of EAMP up to 24 h was 0.31, significantly lower than that (1.03) of the original racemic EAMP (p < 0.01). The changes in the excretion of EAMP and AMP indicated a stereoselective disposition, but those of p-OH-EAMP and p-OH-AMP were unremarkable: the d- and the l-isomer of p-OH-EAMP and p-OH-AMP did not differ significantly. The entire amount excreted up to 24 h was about 71.43% of the dose administered; the d-isomer 37.45% and the l-isomer 33.98%. The l/d was 0.91, which was clearly less than that of the original racemic EAMP (p < 0.01). These results suggested stereoselective disposition of EAMP in the rat, and the methods are potentially applicable to identification of the optical activity of EAMP and thereby of methamphetamine abusers.

Segmental pericholangial fibrosis: a peculiar benign fibrosing disease at the hepatic hilum

The authors report on a 9-year-old child who underwent surgery to remove a tumor of the hepatic hilum with preoperative radiographic studies suggestive of malignancy, but whose surgical specimens showed a peculiar fibrosing disease. The lesion was localized to the bifurcation of the hepatic duct, where the bile duct wall and the surrounding tissue was markedly fibrotic. No malignant cells or epithelial destruction were seen. The patient's postoperative course was uneventful, and he is without any sign of recurrence 2 years after surgery. Because the histological features of this case do not correspond to any established disease, including primary sclerosing cholangitis, the authors believe it represents a new entity, segmental pericholangial fibrosis. Local resection resulted in a good outcome. A review of the literature disclosed a few similar cases with a benign clinical course.

Evaluation of five polymorphic microsatellite markers for typing DNA from decomposed human tissues--correlation between the size of the alleles and that of the template DNA

For PCR-based genotyping using polymorphic microsatellite markers, DNA from decomposed postmortem human tissues was fractionated into six groups according to molecular size. The minimum required amounts of this degraded DNA, for detecting alleles at five microsatellite loci (ACTBP2, CMAG, HUMTH01, CYP19, and LPL) and one minisatellite locus (MCT118) were investigated respectively. The allele patterns were detected by electrophoresis of the PCR products on a 6%-denaturing polyacrylamide gel following silver staining. The detection of alleles for the loci with large allele size required more template DNA with higher molecular size than for that with small allele size. Amounts from 0.3 ng to 5 ng were needed for allele detection on genomic DNA from fresh blood. When the decomposed DNA mixture was used as the template, approximately ten times the amount of genomic DNA was required to detect alleles at the three loci of LPL, CYP19 and HUMTH01, while 24 to 67 times was required for the loci, CMAG, ACTBP2 and MCT118. It was demonstrated that a minimum molecular, size and amount of template DNA was needed for amplifying alleles of the six loci, and degraded DNA less than minimum size in the samples would prevent the detection of the loci which have large allele size.

[Cerebral infarction and asymptomatic arteriosclerosis obliterans in the elderly]

We examined the associations between cerebral infarction (CI), asymptomatic arteriosclerosis obliterans (ASO), and known risk factors for these diseases. The subjects were 67 elderly patients (11 men and 56 women, mean +/- SD age of 79.6 +/- 8.5 years). in 44 patients CI was diagnosed by CT scan; 23 were classified as having cortical infarction and 21 as having lacunar infarction. In 41 patients asymptomatic ASO was diagnosed by an ankle-pressure index (API) of less than 0.9. To identify risk factors for these diseases, we examined the association among these diseases and hypertension (blood pressure > or = 140/90 mmHg), hypercholesterolemia (total cholesterol concentration > or = 220 mg/dl), hypertriglyceridemia (triglyceride concentration > or = 150 mg/dl), low HDL-cholesterolemia (HDL-C concentration < 40 mg/dl), high LDL-cholesterolemia (LDL-C concentration > or = 150 mg/dl), and glucose intolerance (fasting blood sugar concentration > or = 110 mg/dl). The incidence of asymptomatic ASO in the subjects with CI was significantly higher than that in the subjects without CI (chi 2 test; p < 0.05, odds ratio 6.4), including cortical infarction (p < 0.05, odds ratio 8.9) and lacunar infarction (p < 0.05, odds ratio 3.8). Patients with lacunar infarction were more likely to have hypertension than were controls (p < 0.05). Cortical infarction was not associated with these risk factors. Both low HDL-C and high LDL-G were more common in patients with asymptomatic ASO than patients without asymptomatic ASO (p < 0.05). These results indicate that CI and asymptomatic ASO are strongly associated in the elderly, especially in subjects with cortical infarction, and that aging itself contributes to cortical infarction.

Time-lapse changes of d- and l-enantiomers of racemic (dl)-ethylamphetamine in human urine

The time-lapse changes of d- and i-forms in urine specimens collected in the 24 h after the oral dosing of two adult male subjects with 20 mg of racemic (dl)-ethylamphetamine (EAMP)-HCl were examined by high-performance liquid chromatography. The percentage of the excreted dose of nonmetabolized l-EAMP was larger than that of d-EAMP, and the percentage of the excreted dose of metabolized l-amphetamine (AMP) was smaller than that of d-AMP in both subjects, A and B. These differences were observed 4.5-24 h after administration of the drug. The changes in the l/d ratio of EAMP and AMP were not similar between subjects A and B, but the change in the total l/d ratio was nearly the same. The regression line for subject A was as follows: y = 0.021323x + 0.98399. The regression line for subject B was as follows: y = 0.020947x + 0.94893. These two regression lines suggested that the time lapsed after the administration to humans could be predicted. The total percent of the excreted doses of EAMP and AMP was 47.46% (the d-forms, 20.73%; the l-forms, 26.73%) for subject A and was 31.43% (the d-forms, 14.14%; the l-forms, 17.29%) for subject B. The l/d ratio was 1.29 for subject A and 1.22 for subject B, which was somewhat higher than that (1.01) of the dl-EAMP-HCl used.

Clinical features of prognosis of Japanese patients with anomalous origin of the coronary artery

Anomalous origin of the coronary artery can lead to angina pectoris, acute myocardial infarction or even sudden death in the absence of atherosclerosis. However, in Japan, this anomaly is usually treated medically rather than surgically. To clarify the clinical features of anomalous origin of the coronary artery in Japanese and the prognosis of such patients who are treated medically, we reviewed 56 patients with anomalous origin of the coronary arteries. The mean age of these patients was 55.9 +/- 11.5 years. Anomalous origin of the right coronary artery from the left sinus of Valsalva was seen most frequently (78.6%). In contrast, we found no cases of anomalous origin of the left coronary artery from the right sinus of Valsalva traversing between the aorta and the pulmonary trunk. A history of syncope (14.3%) and aorta regurgitation (21.4%) was frequent and serious complications during exercise stress testing occurred in 5 patients. These patients were treated medically, such as by limiting exercise or by the oral administration of medicine. During the follow up period (mean 5.6 +/- 4.2 years), death directly related to anomalous origin of the coronary artery was not found despite the lack of surgical treatment. Our results suggest that the prognosis of these middle-aged-to-elderly patients without atherosclerosis is relatively good, despite the lack of surgical treatment.

Hyperthyroidism complicated with sick sinus syndrome

A 50-year-old woman was transported to a hospital complaining of marked general malaise and epigastralgia with diarrhea and vomiting. Her electrocardiogram showed sinus arrest with a duration of nearly 8 sec. Atrial pacing with an external pacemaker improved her symptoms promptly. Following transfer to our hospital 3 days later, bradyarrhythmia was not detected despite the removal of the external pacemaker. Transient atrial fibrillation was found in our hospital, and she was diagnosed as hyperthyroidism based on findings of finger tremor, exophthalmos, diffuse goiter and an abnormally high level of thyroid hormone. On cardiac catheterization, left ventriculography showed anterior wall hypokinesis and mild mitral regurgitation. Coronary arteriography showed the absence of organic stenosis. Right ventricular endomyocardial biopsy showed myocardial hypertrophy and partial disarray, but no findings of myocarditis. Electrophysiological study showed the normal upper range of AH-time (120 msec) and HV-time (50 msec), and prolongation of corrected sinus recovery time (CSRT, 955 msec). After a euthyroid state was successively induced for about 10 days by methylmercaptoimidazole therapy, AH-time, HV-time and CSRT were shortened to 85, 35 and 290 msec respectively. Her complaints and sick sinus syndrome disappeared after the treatment of hyperthyroidism without a pacemaker.

[Persistent carotid-superior cerebellar artery anastomosis presenting with cerebellar ischemic attack: a case of persistent trigeminal artery variant]

A rare case of persistent primitive trigeminal artery variant (PTAV) with cerebellar ischemia is reported. A 23-year-old male complained of sudden dizziness and nausea after playing valley ball. CT scan and MRI on admission revealed no abnormal findings. Left carotid angiography demonstrated a PTAV anastomoting precavernous portion of left internal carotid artery to the left superior cerebellar artery. The 37 cases reported in literature were reviewed to characterise PTAV. Ninety-seven% of the cases arising from precavernous portion of internal carotid artery, and terminated in anterior inferior cerebellar artery in 73%, posterior inferior cerebellar artery in 13.5% and superior cerebellar artery in 13.5%. Approximately 22.2% of patients with PTAV have cerebral aneurysms. The hypotension or mechanical compression of PTAV on playing valley ball with poor vascular supply to the part of cerebellum possibly caused cerebellar ischemia in this case.

Time course study of the extracellular matrix in puromycin-aminonucleoside-induced glomerulosclerosis

The purpose of this study was to investigate the mechanism of glomerulosclerosis, which is an important histopathological feature of various renal diseases. Puromycin aminonucleoside (PAN) was administered to rats to produce glomerular lesions, and the kidneys were examined by repeated renal biopsy with light microscopy and immunohistochemical detection of glomerular extracellular matrix (ECM) components (laminin, fibronectin, type I, III, and IV collagen). Immunohistochemical studies utilizing the streptavidin-biotin method showed marked accumulation of laminin and type IV collagen in the adhesions between the glomerular epithelium and Bowman's capsule, as well as in the mesangial matrix. Fibronectin was detected in the normal mesangium and the basement membrane of Bowman's capsule, while adhesions and the matrix accumulations were also positive. The sclerotic lesions of the glomeruli were also stained for type I and III collagen, which exist in normal interstitial tissue, but never in healthy glomeruli. Type I collagen appeared in the lesions after type III collagen. All of the ECM components examined in this study were present in advanced glomerulosclerosis and showed distinctive patterns of progression. These finding suggest that abnormal accumulation and production of ECM components in the glomeruli may have a role in the development of glomerulosclerosis.

[Prediction of outcome in putaminal hemorrhage]

We obtained information on patients with putaminal hemorrhage (3,638 medically treated cases and 3,372 surgically treated cases). With these data, we have developed easily applicable and clinically useful prediction models for both mortality and activities of daily living (ADL) at three months after admission. We derived these models by Hayashi's discriminant technique for categorical data. Before their derivation, variables generally available on the initial day of hospitalization and possibly related to outcome were examined individually with tests of homogeneity. Neurological grading (NG), age, deformity of cisterns around midbrain, midline shift, hematoma volume, and motor paralysis were identified as candidate predictors of both mortality and ADL. CT classification was also added to the predictors of ADL. Initially, all these factors were included in tentative models, and then those which were found not to contribute substantially to the prediction were deleted. Ultimately, we proposed two models, one for mortality and the other for ADL. The mortality model used NG, hematoma volume, and deformity of cisterns around midbrain as predictors, and the ADL model used age, NG, CT classification, hematoma volume, and motor paralysis. Average correct classification rates were 87% (medical) and 69% (surgical) for mortality, and 64% (medical) and 60% (surgical) for ADL. With these models, we evaluated indications of both kinds of treatment by comparing each predicted ADL of the medically treated cases with that of the surgically treated cases.

[Measurement of PCNA labeling index in astrocytic tumors]

PCNA (proliferating cell nuclear antigen) is said to be present specifically in the nucleus of proliferating cells. The PCNA labeling index (PCNA LI) of astrocytic tumors was measured and compared with histological types or prognosis. The specimens from 44 patients were fixed in a 10% formalin solution, and embedded in paraffin. The 3 microns-sections were stained immunohistochemically with anti-PCNA monoclonal antibody (PCIO, Novocastra) using an ABC method. The percentage of PCNA-positive-cells was determined by counting 2000 cells, and identified as PCNA LI. All of the PCNA-positive-cells showed diffuse nucleoplasmic staining. The averages of PCNA LIs in each pathological type were calculated and evaluated statistically. Although differences in averages of PCNA LIs among pilocytic, gemistocytic, fibrillary astrocytoma were not significant, there was a significant difference between anaplastic astrocytoma and glioblastoma. The relationship between PCNA LIs and the prognoses for 43 patients was studied. Forty-three patients were classified into 3 groups (over 22%, 7 to less than 22%, and less than 7%) according to PCNA LIs. The survival data in the 3 groups were analyzed, and differed significantly in the survival rates. Furthermore, twenty-three patients of anaplastic astrocytoma and glioblastoma were classified into two groups (over 22% and less than 22%). Likewise, the two groups differed significantly. In summary, pathological type and prognosis were closely related to PCNA LI in astrocytic tumors. Therefore, we thought measurement of PCNA LI would make it more possible to analyze clinically the proliferating activity of astrocytic tumors, and to care for patients more effectively.

Adhesion between the resin shell and composite resin

Adhesiveness between the resin shell and composite resin was examined. As the resin shell, SR-PE-ISOCETTE, made from thermosetting crown and bridge resin, was used. The shear bond strengths between the resin shell and photocurable composite resin bonded by various methods were measured after 1-day of immersion in water at 37 degrees C. Super-bond C & B treatment to the resin shell effectively improved the adhesiveness, giving a bond strength of about 14 MPa. Clearfil new bond, Clearfil porcelain bond, Unifast and MMA/TBBO treatment gave almost the same bond strengths of about 7-9 MPa. Silane coupling agents were not effective for improving the bond strength. It was revealed that 4-META was necessary for obtaining good adhesion between SR-PE-ISOCETTE and composite resin.

Spherical liquefaction necrosis of mitral annular calcification in a chronic dialysis patient--liquefaction necrosis of mitral annular calcification

A 60-year-old woman on chronic dialysis consulted our department for closer examination of transient atrial fibrillation and a mitral regurgitant murmur. Echocardiography revealed a left atrial abnormal dense echogenic spherical mass, the diameter of which was 2 cm. She died of cerebral bleeding 3 months later. At autopsy, the submitral mass-like structure consisted of light-gray pasty material, which was liquefaction necrosis of a mitral annular calcification. These findings were different from those of the so-called mitral annular calcification found in the elderly or in chronic renal failure patients. The existence of such calcification must be kept in mind and not be mistaken for cardiac tumor.

[The effect of elastase on aminonucleoside nephrosis--on renal vascular system]

This study was performed to investigated the relationship between cross sectional areas of glomerular arterioles and glomerular volume in rats with puromycin aminonucleoside (PAN)-induced nephrosis, which is an experimental model of glomerular sclerosis. We also evaluated the effect of an anti-arteriosclerotic agent, elastase on these parameters. Six-week-old male Sprague-Dawley rats were divided into 3 groups; control, PAN-treated (70 mg/kg i.p.), or PAN+elastase-treated (5 mg/kg/day i. m.) group. After 12 weeks of experimental period, microvascular cast of the kidney was prepared, and the cross sectional areas of afferent and efferent arterioles as well as glomerular volume were measured using scanning electron microscopy. In the juxtamedullary glomeruli with minor abnormalities, the efferent arteriole was narrower in PAN-treated rats than in the control rats and the elastase-treatment partially corrected it (control 55.7, PAN 35.9, PAN+elastase 43.7 x 10 microns 2). On the other hand, the cross sectional area of afferent arteriole was not different among the 3 groups. In glomeruli showing sclerosis, the cross sectional area of efferent arteriole correlated positively with the glomerular volume. There results suggest that constriction of the efferent arterioles contributes to the development of glomerular sclerosis in PAN-induced nephrosis. In addition, elastase possibly inhibits this process and thereby protect glomeruli from sclerosis.

The influence of surface conditions and silane agents on the bond of resin to dental porcelain

The influence of porcelain surface condition and the application of silane agents on the adhesion between resin and dental porcelain were investigated. The experimental variables included three porcelain surface preparations, as polished, etched with phosphoric acid, or etched with hydrofluoric acid and three kinds of commercially available silane coupling agents. The shear bond strength between the light-cured composite and the dental porcelain was measured after one-day immersion in 37 degrees C water. Samples without the silane agent application were also tested as controls. Without the silane agent, hydrofluoric acid-etched specimens had a higher bond strength than polished or phosphoric acid-etched specimens. The combination of hydrofluoric acid-etching and an application of Cosmotech Porcelain Primer increased the bond strengths more than that of phosphoric acid-etching. With the application of Laminabond Porcelain Primer or Optec Silane Coupling Agent, high bond strengths were obtained regardless of the porcelain surface condition. Therefore, it seems the chemical reactions between the porcelain surface and silane agents were responsible for the high shear bond strengths.

Mesangial anionic sites are decreased in human focal glomerular sclerosis

We studied the mesangial anionic sites in two patients with focal glomerular sclerosis (FGS), using polyethyleneimine as a cationic probe. The mesangial negative charge in the FGS patients was less than that in three control patients. The decrease in negative charge in FGS concerned the central, paramesangial, as well as the subendothelial region of the mesangium; the decrease was most pronounced in the central region. It is proposed that loss of mesangial negative charge may have pathogenic significance in FGS.

Morphometric analysis of the glomerular capillary area--a comparison of minimal change nephrotic syndrome, focal glomerular sclerosis, and pre-eclampsia

A morphometric analysis was performed to compare the capillary area in non-sclerotic glomeruli in focal glomerular sclerosis (FGS), pre-eclampsia with focal sclerotic change of the glomeruli, and minimal change nephrotic syndrome (MCNS). The mean and standard deviation of the capillary area was greater in FGS than in pre-eclampsia and MCNS. Tubulo-interstitial lesions, such as tubular atrophy, interstitial fibrosis, and lymphocytic infiltration, were more severe in FGS than in pre-eclampsia. The presence of tubulo-interstitial changes including tubular atrophy and interstitial fibrosis with lymphocytic infiltration is thought to be an important prognostic factor in pre-eclampsia as well as in FGS. Unequal dilatation of the glomerular capillaries in non-sclerotic glomeruli may be harmful to the glomeruli and may lead to the development of glomerular sclerosis.

Changes of anionic sites in the mesangium with aging in rats: a comparison of the immersion and intravenous PEI methods

We investigated the changes in anionic sites of the mesangial matrix related to aging in rats, employing polyethyleneimine (PEI) as a cationic probe. We compared the numbers of anionic sites detected by the immersion method and by the intravenous administration of PEI. Analysis of the mean numbers of PEI particles per 0.1 micron2 in the mesangial matrix revealed a significant decrease related to aging. Our results suggested that there was no significant difference in efficacy between the immersion and intravenous methods. Loss of negative charge of the mesangial matrix is believed to promote mesangial dysfunction and the entrapment of macromolecular substances, and so to play an important role in the onset of glomerular sclerosis.

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 +/- 138.4 mg/day) was observed in the CUH rats. Immunoperoxidase staining for IgM, C3 and IgG was positive in the glomeruli, 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 micron2 vs. 6,847 microns2). On the other hand, glomerular hypertrophy was observed in non-sclerotic glomeruli of CUH rats (superficial glomeruli; 12,477-16,123 microns2, juxtamedullary glomeruli; 14,635-18,418 microns2). 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.

Aneurysm of the distal anterior inferior cerebellar artery unrelated to the cerebellopontine angle: case report

This is a case report of an unusual aneurysm of the distal anterior inferior cerebellar artery. A 44-year-old woman had a severe frontal headache and vomiting of sudden onset. On the day after admission, the patient began to demonstrate nuchal rigidity and difficulty with upward gaze bilaterally. There were no complaints at this time suggestive of a syndrome of the cerebellopontine angle. A computed tomographic scan revealed an intraventricular hemorrhage of the 3rd and 4th ventricles; however, multiple attempts at four-vessel angiography were required before an aneurysm could be demonstrated. On the 28th hospital day, a suboccipital craniectomy using the retromastoid approach in the lateral position was performed. A saccular aneurysm with a surrounding hematoma in the distal anterior inferior cerebellar artery was found and clipped. The operative findings revealed that the aneurysm was unrelated to the cerebellopontine angle. After surgery, the patient had an uneventful recovery and complete resolution of symptoms.

Pulmonary infiltrates with eosinophilia due to naproxen

An increasing number of drugs have been implicated in the etiology of eosinophilic pneumonia characterized by the development of pulmonary infiltrates, and peripheral blood eosinophilia. Naproxen is a commonly used nonsteroidal anti-inflammatory drug which may be added to the growing list of pharmacologic agents associated with infiltrative pulmonary lesions. A case of eosinophilic pneumonia induced by Naproxen is described. The results of TBLB, a lymphocyte stimulation test, and a challenge test supported this diagnosis.

[Study on prototype cylindrical HAP]

Hydroxyapatite (HAP) is currently utilized as biomaterials for implantation or reconstruction of bone defect in dentistry. In order to obtain better physical properties and biocompatibility, we have developed cylindrical sintered porous HAP which has longitudinal internal tubules. We measured compressive strength and specific surface area of cylindrical HAP. In the results, compressive strength was more 300MPa on average and specific surface area was 1.7-2.4 folds as HAP ceramics commercially available. This result indicates new bone formation. Cylindrical HAP used was subsequently applied to lower premolars and molars of male beagle dogs (1.5 years). We have implanted cylindrical HAP to bone defect of postextraction of tooth followed to sacrifice six months after. Specimens of bone block were stained with Villanueva bone stain and observed with fluorescence microscope and scanning electron microscope. New tissue formation was observed invading into tubules of 27 microns diameter of cylindrical HAP particles. This new tissue was confirmed to be bone tissue because the proportion of Ca to P was 1.616 obtained by energy dispersive X-ray analyzer.

[The evaluation of commercially available silane coupling agents for porcelain adhesion]

We investigated the effectiveness of commercially available silane coupling agents on the adhesion between the composite resin and the porcelain. As silane coupling agents, we used Cosmotech primer. Clearfil porcelain bond. Porcelain liner M, and Scotchprime. As porcelain, we used Cosmotech porcelain DA2 which was etched either with hydrofluoric acid or with phosphoric acid gel. The tensile bond strengths between composite resin and the porcelain treated with silane coupling agents were measured after one day immersion in 37 degrees C water. Among the silane coupling agents, Clearfil porcelain bond gave the highest bond strength of about 175 kgf/cm2. When any of these silane coupling agents were used, the bond strengths were increased more by hydrofluoric acid etching than by phosphoric acid etching. Especially in the case of Scotchprime treatment, hydrofluoric acid etching was remarkably effective on the increase in the bond strengths. The value in hydrofluoric acid etching was 3 times higher than that in phosphoric acid etching. From SEM observation, hydrofluoric acid etching gave greater roughness to the porcelain surface, which resulted in greater mechanical interlocking of the resin. In the case of Cosmotech primer treatment, the combination with GC bonding agent did not increase the bond strengths, while combination with Clearfil new bond did. The phosphoric acid ester monomer in Clearfil new bond, which is known as strong acid, was supposed to catalyze the activation of silane coupling agent.

Left atrial myxoma presenting as acute myocardial infarction

A 58-year-old man with left atrial myxoma complicated with acute myocardial infarction is presented. On coronary arteriography, 50% stenosis and a saccular aneurysm was found just below the stenosis at segment 1 of the right coronary artery. Ergonovine provocation study was negative. It was proposed that the myocardial infarction probably was caused by coronary embolization from the left atrial myxoma.

[A case of traumatic syringomyelia which disappeared after anterior decompression: a suggestion for surgical treatment of syringomyelia]

A 37-year-old man had received cervical spinal-cord injury 20 years previously. Recently, he complained of progressive spastic gait and was shown to have fracture dislocation of the C5 vertebral body which compressed the spinal cord posteriorly. He also had a syrinx from the C5 to C2 vertebral level. Postoperatively, this syrinx disappeared after anterior decompression of the C4 and C5 vertebral bodies. Such a case as this has never been reported, and this case may give a suggestion for surgical treatment of syringomyelia, because it is very natural that the most reasonable treatment of any disease is removal of the cause.