Minimal damage during endoscopic latissimus dorsi muscle mobilization with the harmonic scalpel

BACKGROUND

To reduce wound-related complications, a video-assisted surgical technique has been adopted for the mobilization of the latissimus dorsi muscle. We postulated that thermal damage to the muscle might be minimized by using a Harmonic Scalpel instead of electrocautery during this procedure.

METHODS

Canine latissimus dorsi muscles were mobilized through a small incision, assisted by a videoscope. In 6 dogs, dissection with electrocautery was used to mobilize the latissimus dorsi muscle. In 6 other dogs, the Harmonic Scalpel was used. We compared operation times, wound infection rates, histologic changes in the muscles, and ease of handling between these groups.

RESULTS

The operation time was significantly shorter in the Harmonic Scalpel group than in the electrocautery group (61.5 versus 106.5 minutes, p = 0.00014). The Harmonic Scalpel caused less histologic damage to the mobilized muscles and produced less vision-obscuring smoke.

CONCLUSIONS

The Harmonic Scalpel shortens the operation, minimizes muscle damage, and facilitates the performance of video-assisted latissimus dorsi muscle mobilization.

[Local recurrence in complete resection for non-small cell lung cancer]

307 patients with complete resection for non-small cell lung cancer between 1989 and 1996 were examined to evaluate the clinical features of local recurrence. Postoperative recurrence was observed in 104 of the 307 patients. At the first recurrence, local recurrences occurred in 21 (20%) of the 104 patients, distant metastases in 72 (69%), and combined recurrences in 11 (11%). 32 patients had local recurrences in 47 localizations, bronchial stump recurrences occurred in 11 (34%) of 47 localizations, hilarmediastinal lymph node metastases in 18 (56%), supraclavicular lymph node metastases in 10 (31%), contralateral mediastinal lymph node metastases in 1 (0%), and malignant effusion in 7 (22%). Lymph node metastases in the hilusmediastinum were the most common mode of the local recurrences (22%), and each mode of solely subclavian lymph node metastases and malignant effusion was 16%. The incidence of local recurrences increased as invasion into the lymphatic and/or blood vessels was demonstrated (p < 0.05). The results of our study implies that despite of lymph node dissection, latent disease persisted in the small lymphatic and/or blood vessels from hilus to subclavian sites. Postoperative adjuvant therapy including radiation will be beneficial to improvement of local control for patients invaded to lymph and/or blood vessels.

[Quantitation of human immunodeficiency virus type 1 RNA by ultrasensitive method in the analysis of samples with low viral load]

With the introduction of combination therapy to the patients with Human Immunodeficiency Virus Type 1(HIV-1) infection, HIV-1 RNA levels in plasma have been reduced, frequently to less than limit of quantitation(400 copies/ml). To achieve enhanced sensitivity, a modified specimen preparation procedure that allows the quantitation of plasma HIV-1 RNA levels as low as 50 copies/ml was developed. Of 67 samples with less than 400 copies/ml of HIV-1 RNA by standard method, 39(58.2%) were not detected by the "ultrasensitive" method. Among 5 samples obtained from patients who were treated with 2 nucleoside reverse transcriptase inhibitors, 4 samples still had detectable copies of HIV-1 RNA. Those suggest that the ultrasensitive assay for HIV-1 RNA has advantage for clinical practice.

Myocardial tactile stiffness during acute reduction of coronary blood flow

BACKGROUND

Evaluation of regional myocardial contractile function is of clinical importance. We have developed a new tactile sensor system for accurate measurement of myocardial stiffness in situ. We found that the myocardial stiffness measured by this sensor, which we call tactile stiffness, can be a very useful index for accurate quantification of regional myocardial function. In this study, we used a coronary stenosis model to investigate regional myocardial tactile stiffness under conditions of reduced coronary blood flow.

METHODS

The myocardial tactile stiffness, coronary blood flow, and ventricular pressure and volume, of five open chest mongrel dogs weighing 15 to 17 kg, were measured. After measuring the baseline myocardial stiffness, coronary arterial stenosis was induced with a balloon occluder.

RESULTS

Reducing the coronary flow to 50% and 25% of the baseline level reduced the end-systolic tactile stiffness significantly from 2.20+/-0.16 g/mm2 to 2.05+/-0.20 g/mm2 (p<0.05) and from 2.21+/-0.16 g/mm2 to 1.96+/-0.18 g/mm2 (p<0.01), respectively. Reducing the flow, to 50% and 25%, increased the end-diastolic stiffness significantly from 1.29+/-0.15 g/mm2 to 1.39+/-0.14 g/mm2 (p<0.01) and from 1.30+/-0.16 g/mm2 to 1.46+/-0.14 g/mm2 (p<0.05), respectively.

CONCLUSIONS

We consider that the regional myocardial tactile stiffness will be a useful index sensitive enough to detect changes in regional contractile function under conditions of reduced coronary blood flow.

Photon statistics and correlation analysis of ultraweak light originating from living organisms for extraction of biological information

Ultraweak photon emission phenomena in the visible to near-IR region, originating from biological organisms, are known. This biophoton emission is generated during metabolic processes and constitutes physiological information. We investigated a technique for characterizing the optical radiation field based on photon statistics and correlation analysis to extract information on regulation processes in biochemical reactions and their interactions. We developed the system based on the time-interval measurement of photoelectrons in a photon-counting region and employed data processing with a nonstationary optical field with correction for the correlative properties of the photomultiplier dark current. We analyzed biophoton emission from cellular slime mold (Dictyosterium discoideum) and observed the characteristic variation of this organism's super-Poisson statistics during the developmental process.

Cardiac rupture by penetration of fractured sternum: a rare complication of cardiopulmonary resuscitation

We report an 82-year-old man in whom cardiopulmonary resuscitation (CPR) was unsuccessful. The postmortem examination revealed right atrial ruptures and pericardial sac perforation by a fractured sternal edge. Even though CPR-related cardiac rupture is rare, emergency medical staff should be aware of this complication.

Measurement and prediction of hydrophobicity parameters for highly lipophilic compounds: application of the HPLC column-switching technique to measurement of log P of diarylpyrazines

In the preparatory stage of structure-activity relationship (QSAR) studies of anti-platelet aggregant pyrazine derivatives, log P values (P: 1-octanol/water partition coefficient) of diarylpyrazines were measured by a newly developed HPLC column-switching technique. The system consists of two processes: (1) adsorption of the sample at the top end of a short precolumn, and then (2) quantifying the enriched analyte by a conventional analytical column. By using the log P values thus obtained, the correction factor for the steric hindrance caused by the vicinal diphenyl groups was estimated. The log k values (k; retention factor) were also measured with methanol-buffer (pH 7.4) eluents and related to log P. The eluent of 50% methanol content (M50) gave a good linear relationship over a wide range of log P (-0.3< log P < 5.2), indicating that log k(M50) parameter is useful for predicting the log P value.

Two-dimensional photon counting imaging and spatiotemporal characterization of ultraweak photon emission from a rat's brain in vivo

The process of metabolic reactions within living cells leads to spontaneous ultraweak light emission. The development of a system for highly sensitive imaging and spatiotemporal analysis of ultraweak photon emission from a rat's brain is reported in this paper. The equipment used in this experiment consists of a two-dimensional photon-counting tube with a photocathode measuring 40 mm in diameter, a highly efficient lens system, and an electronic device to record time series of a photoelectron train with spatial information. The sensitivity and ability to extract spatiotemporal information from sequential data of a single photoelectron train were examined. The minimum detectable radiant flux density of the system was experimentally estimated to be 9.9 x 10(-17) W/cm2 with a 1-s observation time. Spontaneous photon emission was demonstrated from an exposed rat's cortex in vivo without adding any chemical agent or employing external excitation. An image of ultraweak photon emission was compared with one obtained after cardiac arrest. The intensity after cardiac arrest was depressed to approximately 60% of before that. The regional properties of time courses of emission intensity were also demonstrated, indicating the potential usefulness for spatiotemporal characterization of photon emission with mapping of physiological information such as oxidative stress. This technology constitutes a novel method, with the potential to extract pathophysiological information from the central nervous system.

Adaptive computer-based spatial-filtering method for more accurate estimation of the surface velocity of debris flow

An adaptive computer-based spatial-filtering velocimeter to measure the surface velocity of a natural debris flow with high accuracy is described that can adjust the filter parameters, specifically, the slit width of the filter, based on the surface-pattern characteristics of the flow. A computer simulation confirms the effectiveness of this technique. The surface velocity of a natural debris flow at the Mt. Yakedake Volcano, Japan, was estimated by this adaptive method, and the results were compared with those obtained by two other methods: hardware-based spatial filtering and normal computer-based spatial filtering.

mRNA expression of variant Fas molecules in acute leukemia cells

Fas (Apo-1/CD95) is a cell membrane receptor involved in apoptotic cell death. Soluble variant forms (sFas) lacking the transmembrane domain due to alternative splicing have been identified. Up-regulation of sFas expression is reportedly implicated in prereceptorial blockage of Fas-induced apoptosis in a dose-dependent manner. We examined mRNA expression of Fas and sFas in fresh leukemia cells. All leukemia cells expressed both mRNAs of full-length Fas (FasFull) and sFas with deletion of exon6 (FasDel6). The ratio of FasFull/FasDel6 mRNA expression was not always correlated with Fas-mediated growth inhibition. Interestingly, in a 6-year-old boy with acute myelogenous leukemia, blast cells obtained at onset and at the time of bone marrow relapses expressed distinct amounts of FasDel6 mRNA. Furthermore, the level of FasDel6 expression appeared to be correlated with Fas-resistance in leukemia blasts. In addition, sFas protein levels were elevated in patients' sera at onset with subsequent return to normal levels after complete remission. These results indicated that sFas could be synthesized and released by leukemia blasts and suggested that up-regulation of Fas variant transcript might render leukemia blasts resistant to Fas-mediated growth inhibition in certain cases.

Epitopes and functional responses defined by a panel of anti-Fas (CD95) monoclonal antibodies

Fas (CD95) is a cell surface glycoprotein that mediates apoptotic cell death when cross-linked with agonistic anti-Fas monoclonal antibodies (MAbs) or the endogenous Fas ligand. In this study, we investigated the in vitro biological properties of a panel of anti-human Fas MAbs. We found that five anti-Fas MAbs of IgG1 subclass (B.E28, B.G30, B.L25, DX2, and B.G34) induced marked apoptotic cell death in Fas-expressing leukemia cells, although this killing was delayed when compared to the cytolytic effect mediated by the prototypic anti-Fas MAb of IgM subclass (clone CH-11). On the other hand, four clones (ZB4, B.G27, B.D29, and B.K14) efficiently blocked apoptotic cell death induced by the CH-11 MAb or Fas ligand. The ability of these MAbs to inhibit cell death appeared to correlate with their relative affinity for the Fas molecule. Furthermore, different clones recognized the same epitope and elicited different effects (induction or inhibition of cell killing); conversely, different clones elicited the same effect but recognized different epitopes. These results suggest that the different biological effects of anti-Fas MAbs would not be mediated in an epitope-restricted manner. The relative binding affinity might correlate to some extent with the biological properties of the MAb.

The effective removal of proinflammatory cytokines by continuous hemofiltration with a polymethylmethacrylate membrane following severe burn injury: report of three cases

The serum levels of proinflammatory cytokines were investigated in three patients with severe burn injuries complicated by sepsis and pulmonary edema, who were treated with continuous hemofiltration (CHF) using a polymethylmethacrylate (PMMA) membrane. All patients had suffered burn injuries to more than 30% of their total body surface area (TBSA) and had burn indexes of 20 or more. Both interleukin (IL)-6 and tumor necrosis factor-alpha were detectable in one patient, while the serum IL-6 levels were elevated in the remaining two patients. The serum cytokines decreased 24 h after the initiation of CHF. Determinations of IL-6 in inflow and outflow blood samples as well as in the filtration fluid revealed that IL-6 was ultrafiltrated and/or adsorbed by the filter. Two of the three patients did not survive. Nevertheless, the results of this study indicate that since burn injuries are frequently associated with hypercytokinemia, the removal of cytokines by CHF with a PMMA membrane may be effective in the management of severe burn injuries.

The effect of thorough preoperative disinfection on the incidence of postoperative mediastinitis

This study was conducted to evaluate the effectiveness of scrubbing the skin of patients scheduled to undergo elective cardiac surgery with disinfectant solutions in an attempt to reduce the incidence of the potentially fatal postoperative complication of mediastinitis. Since April 1991, we have routinely disinfected the skin of all such patients three times preoperatively. A retrospective comparison of the incidence of mediastinitis before and after April 1991 was carried out. Microbiological examinations of the anterior chest were conducted in ten patients admitted for elective operations, and in four patients admitted for emergency surgery. Specimens were obtained before each scrubbing, before the operation, and just after skin closure. There was a significant decrease in the general incidence of mediastinitis after April 1991 (P < 0.01). Microbiologically, significant decreases in colony counts were also observed after the first (P < 0.05) and second scrubbing (P < 0.05) in the ten patients specifically studied before elective surgery. No colonies grew in the postoperative specimens from any of these patients, but colony formations were observed in two of the four patients who underwent emergency surgery (P = 0.066). Thus, we conclude that our thorough disinfection method effectively achieves adequate, prolonged suppression of the skin flora, which explains the marked decrease in the incidence of mediastinitis in our hospital since its institution.

Usefulness of procalcitonin in Pseudomonas burn wound sepsis model

Procalcitonin (PCT), a precursor of calcitonin, and endotoxin were determined in the burn wound sepsis model in which 21 Sprague-Dawley rats were scalded approximately 30% on their back. On day 2 post burn, the wounds were inoculated 1 x 10(8) colony-forming units of Pseudomonas aeruginosa. On day 5 post burn P. aeruginosa was detected by blood culture in 10 of the 21 rats (47.6%). The mortality rate 7 days after burn was 90.5%. Significant correlations were observed between serum endotoxin levels and serum PCT levels on day 5 post burn (r = 0.860, p<0.001). It was suggested that endotoxin may induce the release of PCT and that measuring the levels of PCT may be useful in diagnosing burn wound sepsis.

In vivo imaging of spontaneous ultraweak photon emission from a rat's brain correlated with cerebral energy metabolism and oxidative stress

Living cells spontaneously emit ultraweak light during the process of metabolic reactions associated with the physiological state. The first demonstration of two-dimensional in vivo imaging of ultraweak photon emission from a rat's brain, using a highly sensitive photon counting apparatus, is reported in this paper. It was found that the emission intensity correlates with the electroencephalographic activity that was measured on the cortical surface and this intensity is associated with the cerebral blood flow and hyperoxia. To clarify the mechanism of photon emission, intensity changes from whole brain slices were examined under various conditions. The removal of glucose from the incubation medium suppressed the photon emission, and adding 50 mM potassium ions led to temporal enhancement of emission and subsequent depression. Rotenone (20 microM), an inhibitor of the mitochondrial electron transport chain, increased photon emission, indicating electron leakage from the respiratory chain. These results suggest that the photon emission from the brain slices originates from the energy metabolism of the inner mitochondrial respiratory chain through the production of reactive oxygen. Imaging of ultraweak photon emission from a brain constitutes a novel method, with the potential to extract pathophysiological information associated with neural metabolism and oxidative dysfunction of the neural cells.

Chromosome abnormalities and MLL rearrangements in acute myeloid leukemia of infants

Of 29 infants with acute myeloid leukemia (AML), 14 (48%) had various 11q23 translocations. MLL rearrangements were examined in 21 of the 29 patients, and 11 (52%) showed the rearrangements. 11q23 translocations and/or MLL rearrangements were found in 17 (58%) of the 29 patients. While all but one of the 17 patients with 11q23/MLL rearrangements had M4 or M5 type of the FAB classification, the 12 patients without such rearrangements had various FAB types, including M2, M4, M4EO, M6 and M7. Of the 12 patients with other chromosome abnormalities or normal karyotypes, two had inv(16) ort(16;16), one had t(1;22)(p13;q13), and two had a novel translocation, t(7;12)(q32;p13). The breakpoint on 12p of the t(7;12) was assigned to intron 1 or the region just upstream of exon 1 of the TEL/ETV6 gene by fluorescence in situ hybridization. The event-free survival at 5 years for the 17 patients with 11q23/MLL rearrangements was 42.2%, and that for the 12 patients without such rearrangements was 31.3% (P = 0.5544). 11q231MLL rearrangements have been frequently reported and a poor prognosis in infant acute lymphoblastic leukemia implied. Our study showed that while 11q23/MLL rearrangements were also common in infant AML, AML infants with such rearrangements had a clinical outcome similar to that of AML infants without such rearrangements.

Prevention by methylprednisolone of increased circulating tumor necrosis factor-alpha levels and lung injury associated with systemic inflammatory response syndrome due to intraperitoneal hyperthermia

We previously demonstrated that intraperitoneal hyperthermic perfusion (IPHP), which is performed clinically as a treatment for patients with advanced gastrointestinal cancer, can lead to increased serum tumor necrosis factor-alpha (TNF-alpha), systemic inflammatory response syndrome (SIRS), and acute lung injury. Glucocorticoids inhibit the production and actions of TNF-alpha. We investigated whether pretreatment with methylprednisolone (MPS) may modulate serum TNF-alpha and lung injury in patients subjected to IPHP. Serum TNF-alpha was not detected in the patients pretreated with MPS, whereas serum TNF-alpha increased in the control patients (45.7 +/- 8.3 pg/mL, mean +/- SEM) after IPHP. Postoperative lung injury scores were significantly lower in patients pretreated with MPS than in the control patients (P < 0.001).

IMPLICATIONS

Pretreatment with methylprednisolone attenuates the increase in circulating tumor necrosis factor-alpha and prevents lung injury in this systemic inflammatory syndrome due to intraperitoneal hyperthermic perfusion.

Improvement of thermal effects in a diode-end-pumped, composite Tm:YAG rod with undoped ends

We present comparative studies of the laser performance of a diode-end-pumped, composite Tm:YAG rod with undoped ends. Efficient heat removal in a composite rod can reduce the peak of the rise in temperature in the 2-mm-long active segment by 19% compared with that in a noncomposite rod by theoretical calculation. The threshold pump power was reduced by 10%, and the focal power of the thermal lens was improved by 15%. These improvements permit high output performance and flexible design of laser cavities in diode-end-pumped Tm:YAG lasers.

Anaplastic large cell lymphoma associated with Sjögren's syndrome

We report a case of a 20-year-old Japanese female with recurrent anaplastic large cell lymphoma (ALCL) associated with Sjögren's syndrome (SjS). She was first diagnosed to have ALCL presenting with axillary lymphadenopathy, which within a month underwent spontaneous remission, at the age of 12 years. Eight years later she developed left inguinal lymphadenopathy with clinical overt sicca symptoms associated with elevated serum IgG, interleukin (IL)-1beta and IL-6 levels. Lymph node biopsy was now diagnostic of ALCL characterized by large pleomorphic CD30+ blast cells with the specific chromosomal abnormality, t(2;5)(p23;q35). In contrast to this the salivary gland and renal biopsy revealed infiltration of small lymphocytes, morphologically and cytogenetically distinct from the ALCL cells. Interestingly, SjS symptomatology correlated with disease activity of ALCL and based on an association with elevated IgG and IL-6 levels, suggesting that the concurrence of these two diseases could be more than coincidental. To the best of our knowledge, this is the first reported case of ALCL presenting concurrently with SjS.

Broadband Tuning of a Continuous-Wave, Doubly Resonant, Lithium Triborate Optical Parametric Oscillator from 791 to 1620 nm

We report the use of extreme broadband, high reflectivity >99.5%, optical parametric oscillator (OPO) cavity mirrors. A continuous-wave, doubly resonant, OPO demonstrated tuning over a range of 791-1620 nm with a single mirror set. Wavelength tuning was performed by temperature tuning the nonlinear material of lithium triborate. Narrow linewidth oscillation was confirmed throughout the tuning range, and threshold pump power increased gradually from 50 mW near the degeneracy to 800 mW at the tuning band edge in a double-pass pumping configuration.

Estimation of the surface velocity of debris flow with computer-based spatial filtering

A computer-based spatial-filtering velocimeter to measure the surface velocity of natural debris flow is described. This is a simple and interesting technique implemented with a spatial filter constructed as a software program that processes the video image of debris flow instead of a hardware implementation. The surface velocity of the debris flow at the Mt. Yakedake Volcano, Japan, was estimated by this computer-based spatial-filtering method, and the results were compared with those obtained by a hardware-based spatial-filtering method. Computer-based spatial filtering has the important advantage of a capability for tuning the spatial-filter parameters to the target flow.

Bcl-2 is located predominantly in the inner membrane and crista of mitochondria in rat liver

Bcl-2 is now recognized as a potent inhibitor of apoptotic cell death. It has been reported that Bcl-2 is located in the mitochondria, endoplasmic reticulum, and nuclear membrane in some cell lines, and it is not expressed in normal human and rat liver. An earlier study showed that Bcl-2 is an inner mitochondrial membrane protein. On the contrary, the following investigations using immunoelectron microscopy demonstrated that Bcl-2 resides predominantly in the mitochondrial outer membrane. In this study, using a cryo-sectioning immunogold labeling technique and immunoblotting, we carefully determined the subcellular localization of Bcl-2. Here we report that Bcl-2 is expressed in normal rat liver, and it is located predominantly in the inner membrane and crista rather than in the outer membrane of mitochondria.

Efficient 946-nm Laser Operation of a Composite Nd:YAG Rod With Undoped Ends

We present comparative studies on laser performance of diode end-pumped, composite Nd:YAG rods with undoped ends at 946 nm. Efficient heat removal in a composite rod can reduce the peak of rise in temperature in the active segment to 61% by theoretical calculation. The maximum, continuous-wave output power of 1.5 W, which is three times higher than a conventional noncomposite rod, was obtained at an absorbed pump power of 8 W because of the 55 deg reduction in temperature rise that was estimated experimentally. The performance and characteristics of composite rods in quasi-three-level laser operation are analyzed and discussed in detail, taking into account the reduction in reabsorption loss, which is strongly temperature dependent.

Enhancement of laser CT image contrast by correction of artifacts due to surface effects

Mismatched boundary conditions such as air-sample interface introduce artifacts that obscure internal information in the reconstructed laser computed tomographic (CT) images. Here, we demonstrate enhancement of target structure in the laser CT images by correcting the projection data using the experimentally determined angle dependence of sample surface attenuation. The images reconstructed with the corrected projection data are shown to have improved image contrast. Our proposed correction to laser CT reconstruction is effective for visualizing internal structure with small variations in the attenuation coefficients that would otherwise be masked by the dominant surface attenuation.

Widely Tunable Continuous-Wave CR(3+):LiSrAlF(6) Ring Laser from 800 to 936 nm

We report on a widely tunable, diode-pumped, continuous-wave, single-frequency Cr(3+):LiSrAlF(6) laser with a novel double-ring cavity configuration. The optical diode and the tuning element were located in the ring subcavity to decrease their insertion loss. Using an 1800-lines/mm grating as the tuning element, we obtained a laser emission of 20-mW output power at 870 nm and a tuning range of from 800 to 936 nm. When we used a 1200-lines/mm grating with a higher diffraction efficiency, the laser had a slightly wider tuning range of from 800 to 938 nm. However, the output power decreased at this tuning range.