Nonsurgical treatment of lateral ligament injury of the ankle joint

Between 1986 and 1989, 40 patients with acute lateral ligament injury of the ankle joint were treated by immobilizing their affected feet in a plaster cast with a heel for 4 weeks, followed by a brace for the next 2 months. The average follow-up time was 29 months. Ninety-eight percent of the patients were rated as having satisfactory functional results. Stress radiographs at the latest follow-up showed good stability even in ankles that were severely unstable at injury. Posttreatment stress radiographs taken periodically showed that stability was maintained 6 months after treatment.

Pseudarthrosis and delayed union after anterior cervical fusion

Anterior cervical spine fusion was carried out on 443 cases between 1965 and 1988 with pseudarthrosis or delayed union in 15 (3.4%). The causes of these complications were malalignment and faulty postoperative care. Symptoms resulted from abnormal mobility, cord compression due to posterior slip or rotation of the upper vertebral body, kyphotic deformity or a problem at the adjacent level. Four out 5 cases with symptoms recovered successfully after a second operation.

Evaluation of cervical diskography in pain origin and provocation

The purpose of this article is to analyze the role of cervical diskography as a diagnostic method via reproduced pain. A nonionic contrast medium (Iohexol) that does not harm normal tissue was used in this series to prevent false-positive provocative pain. One hundred forty-four patients (128 with cervical spondylotic myelopathy, eight with cervical spondylotic radiculopathy, and eight with cervical spondylotic amyotrophy) were studied. Among 72 patients in the symptomatic neck pain group who complained of neck pain before diskography, 65% showed reproduced pain. However, in the control group (neurologic symptoms only) 50% of the patients complained of provocative neck pain during dye injection. These results demonstrated that this provocation technique appeared unreliable for diagnosing symptomatic disk levels.

An analysis of failures in primary cervical anterior spinal cord decompression and fusion

Recently, postoperative results of cervical spondylosis, disc herniation, and ossification of the posterior longitudinal ligament (OPLL) after anterior cervical surgeries have improved. However, occasional unsatisfactory cases needing a second operation remain. We analyzed and developed strategies for multioperated neck (MON) cases; all patients had two operations. From 1965 to 1988, 443 cervical anterior surgeries were performed in our hospitals; 53 (12.0%) of these patients needed second operations. These MON cases were classified by the following causes: pseudarthrosis, graft fracture, insufficient decompression, misdiagnosis, and adjacent disc problems. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described.

Estradiol does not influence myocardial superoxide dismutase activity in rabbits

The influence of sex steroids on myocardial superoxide dismutase (SOD) activity was evaluated in rabbits. No sex differences in SOD activity were observed in male and female rabbits. Castration did not lead to any changes in SOD activity in either sex. Graded doses of estradiol that produced graded increases in uterotropic effect failed to produce any change in myocardial SOD activity. Results indicate that the beneficial effect of estrogen on cardiovascular disease and the sex differences in incidence of cardiovascular morbidity cannot be explained on the basis of a direct action of estradiol on myocardial SOD activity.

Characteristics of cultured subepithelial fibroblasts of rat duodenal villi

Subepithelial fibroblasts, which form a cellular network beneath the epithelium of rat intestinal villi, were cultured, and their morphological characteristics were examined. These fibroblasts, which migrated from epithelium-free villi (isolated primarily from duodenum) were flat in shape after 2 days of culture. The flat cells, each resembling a maple leaf, were rich in bundles of microfilaments, and were connected to each other by a few small gap junctions, ascertained from freeze-fracture and dye-coupling experiments. The morphology of the flat cells changed to a stellate form, with thin processes, within 30 min-1 h of reducing the serum concentration and adding dibutyryl cyclic AMP (dBcAMP), forskolin, and cholera toxin. Upon removal of dBcAMP and addition of fetal calf serum, the cells rapidly reassumed their original flat shape. Cells that were stellate in the presence of dBcAMP reassumed a flat morphology within several minutes after the addition of endothelin-1. This conversion occurred with or without extracellular Ca2+. An accompanying rearrangement of the cytoskeleton during shape conversion was observed by fluorescence immunohistochemistry.

Stress hormone responses to major intra-abdominal surgery during and immediately after sevoflurane-nitrous oxide anaesthesia in elderly patients

We studied the responses of plasma epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) during and immediately after sevoflurane-nitrous oxide anaesthesia supplemented with vecuronium in seven elderly patients (mean 76.6 +/- 1.7 SEM) who underwent major intra-abdominal surgery. The plasma concentrations of norepinephrine, ACTH, cortisol, and ADH increased in response to surgical procedures (P < 0.05). The plasma concentration of ADH increased to a peak concentration of 189.1 +/- 20.7 pg.ml-1 30 min after skin incision (P < 0.05). The plasma concentrations of epinephrine, norepinephrine, ACTH, and cortisol increased to peak concentrations of 408.6 +/- 135.5 pg.ml-1, 635.7 +/- 167.8 pg.ml-1, 222.6 +/- 48.0 pg.ml-1, and 113.6 +/- 67.5 micrograms.dl-1, respectively immediately after tracheal extubation (P < 0.05). We conclude that, in the elderly patients, the responses of stress hormones to major intra-abdominal surgery were preserved during sevoflurane-nitrous oxide anaesthesia sufficient to prevent increases in arterial pressure and heart rate. The strongest responses of epinephrine, norepinephrine, ACTH, and cortisol were elicited immediately after tracheal extubation.

Adenoendocrine cell carcinoma of the gallbladder: a histochemical and immunohistochemical study

A case of adenoendocrine cell carcinoma of the gallbladder with adenomucous cells and neuroendocrine cells is reported. A histochemical and immunohistochemical study revealed that the primary tumor in the gallbladder was composed of mucus-secreting and/or argyrophil cells. Furthermore, the tumor showed a positive reaction to carcinoembryonic antigen (CEA) in all tumor cells, to chromogranin A and cytokeratin in many tumor cells, to endocrine granule constituent (EGC) in some tumor cells, and to serotonin and somatostatin in a few tumor cells. In addition, a few mucous cells showed argyrophilia and EGC-positivity in their cytoplasms. This case suggests that the adenoendocrine cell tumor is derived from endodermal stem cells as a result of bidirectional (exocrine and endocrine) differentiation.

Bronchial atresia: report of a case and review of the literature

We report herein an unusual presentation of bronchial atresia in a 28-year-old woman, in whom hyperlucency of the ventral segment, distal to a right extrahilar mass found on a routine chest X-ray, was not recognized. Atresia of the medial branch of the ventral segmental bronchus (B3b) with mucoid impaction in the dilated bronchus was finally disclosed by a right upper lobectomy. The patient had been asymptomatic, and physical examination demonstrated no abnormal findings such as decreased breathing sounds over the affected lung. Localized hyperlucency and a mass are the characteristic radiographic features of bronchial atresia. In the present case, however, hyperlucency distal to the mass, which was retrospectively evident on a computed tomogram of the chest, was not recognized. The preoperative diagnosis was also made difficult by the fact that the atresia was located on a subsequential branch (B3b) of the ventral segmental bronchus of the right upper lobe. Since computed tomography and magnetic resonance imaging are able to make an accurate diagnosis of bronchial atresia possible, surgery is often not indicated for asymptomatic patients. Moreover, although surgical intervention is required for patients with complications such as encroachment of normal pulmonary tissue or infection, resection should be as limited as possible to preserve normal lung tissue.

Observation of biological materials by X-ray photoelectron-conversion contact microscopy

Dried biological specimens, such as fossil diatoms, collagen, nerve tissue and spicule of Trepang, were observed by X-ray photoelectron-conversion contact microscopy. A spatial resolution of 0.2 microns was attained. The fossil diatom image shows a clear difference below and above the carbon K-absorption edge (4.46 nm).

Effects of postoperative immobilization on the reconstructed anterior cruciate ligament. An experimental study in rabbits

To investigate the effects of postoperative immobilization and limited motion on reconstructed anterior cruciate ligaments, 28 rabbits received an anterior cruciate ligament reconstruction using autogenous Achilles tendon and were then divided into three groups: fully immobilized, 4 weeks immobilized, and limited motion. Two rabbits from each group were evaluated macroscopically, histologically and microangiographically at 4-week intervals until 12 weeks postoperatively. An additional six rabbits in the 4 weeks immobilized and limited motion groups were studied biomechanically at 12 weeks postoperatively. Macroscopically, both immobilized groups showed more proliferation of the infrapatellar fat pad, which was adherent to the reconstructed anterior cruciate ligament. Histology revealed more rapid regeneration of reconstructed anterior cruciate ligaments in the limited motion group, with no findings of necrosis in the mid-substance. Microangiography indicated faster normalization of vascularity in the limited motion group. The biomechanical study showed no significant difference in laxity between the 4 weeks immobilized and limited motion groups. The graft stiffness and maximum load to failure were greater for the limited motion group, although the increase was not statistically significant. The histologic and microangiographic results from the limited number of animals in this study support limited postoperative motion in the anterior cruciate ligament reconstructed knee. However, there were no differences in terms of the biomechanical parameters at 12 weeks postoperatively between the immobilized and limited motion treatment modes.

Brain stem haemorrhage during transsphenoidal surgery. Possible risk of the manoeuvre of increasing the endexpiratory pressure in a case of pituitary adenoma associated with dural arteriovenous malformation. Case report

The authors report a case of pituitary adenoma associated with dural arteriovenous malformation (AVM), which caused brain stem haemorrhage during transsphenoidal surgery. The manoeuvre of increasing the endexpiratory pressure in order to push the suprasellar component of the adenoma down to the sella turcica could be the reason of this bleeding. The authors therefore recommend that in cases of such a combination any manoeuvres which are likely to increase the intracranial venous pressure or otherwise affect the intracranial pressure, are avoided. The dural AVM spontaneously regressed after haemorrhage.

Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament

The effect of tibial and femoral attachment site on the length change and force of an anterior cruciate ligament graft during unloaded flexion in eight cadaver specimens was examined. Two tibial sites (anteromedial and central portion of the anterior cruciate ligament attachment) and three femoral sites (anterior and central portions of the anterior cruciate ligament attachment, and over-the-top) were evaluated. Graft length changes between all combinations of attachment sites were measured from full extension to 150 degrees of passive flexion at 15 degrees intervals using the displacement of a 2-mm inextensible cord. The anterior cruciate ligament was then reconstructed using a Kennedy Ligament Augmentation Device, and graft forces at the same angles of passive flexion were measured with a buckle transducer. Graft length change and force were more affected by the femoral attachment site than the tibial site. There was a close correlation between length change and force measurements in flexion, but not near extension. The pattern of force and length change versus flexion angle for a given combination of attachment sites sometimes varied over the knees tested. Our results suggest that intraoperative isometry measurements are worthwhile for indicating an overloaded graft in flexion; however, length changes near extension may not adequately reflect graft force, creating the possibility that a graft may be more highly loaded than realized.

Proliferation-associated increase in sensitivity of mammary epithelial cells to inositol-1,4,5-trisphosphate

Injection of D-myo-inositol-1,4,5-trisphosphate (IP3) was found to induce a transient increase of intracellular Ca2+ concentration in cancerous mammary cells (MMT060562) and in normal mammary cells treated with epidermal growth factor. Responses to injection of either D-myo-inositol-1,4-bisphosphate (IP2) or D-myo-inositol-1,3,4,5-tetrakisphosphate (IP4) were small or absent. Furthermore, normal mammary cells cultivated with low-protein serum replacement alone or in the presence of differentiation-inducing hormones (insulin + cortisol + prolactin) were less sensitive to IP3. Thapsigargin induced a transient increase of Ca2+ due to the release of Ca2+ from an intracellular pool. There was no difference in the peak heights of the thapsigargin-induced Ca2+ increase when mammary cells were cultivated in the presence or absence of epidermal growth factor or insulin + cortisol + prolactin. These findings suggest that the releasable intracellular Ca2+ pool remained unchanged whereas sensitivity to IP3 increases during the proliferation stage. Mechanical stimulus of a mammary cell induces an increase of intracellular Ca2+ in the stimulated cell. A certain stimulating factor is released from the mechanically stimulated cell into the extracellular space, and it induces an increase of Ca2+ in surrounding cells. In contrast, the IP3-induced Ca2+ increase in both cancerous and epidermal growth factor-treated normal mammary cells did not spread to adjacent cells. Therefore, increase of Ca2+ is not sufficient to account for the release of stimulating substances from mammary cells in the mechanically-induced spreading response.

Release of tumor necrosis factor-alpha from human alveolar macrophages is decreased in smokers

It is known that smoking affects the development and maintenance of certain types of granulomatous lung diseases. To explore this mechanism(s), we measured tumor necrosis factor (TNF)-alpha concentrations in the culture supernatants of lipopolysaccharide (LPS)-stimulated alveolar macrophages (AMs) in 13 healthy nonsmokers, 13 healthy smokers, 13 nonsmoking sarcoid patients, and 16 smoking sarcoid patients. We found that the capacity of smokers' AMs to release TNF-alpha was significantly decreased both in the normal and sarcoid groups. We also confirmed the previous observation that there was an exaggerated TNF release in patients with pulmonary sarcoidosis. These results indicate a significant role of TNF-alpha in the pathogenetic mechanisms of pulmonary sarcoidosis and suggest the possible involvement of TNF in the mechanisms by which smoking modulates local immune phenomena.

Biology and neurobiology of Borna disease viruses (BDV), defined by antibodies, neutralizability and their pathogenic potential

Borna disease viruses (BDV) isolated from more than 20 naturally infected horses, 2 sheep and a possible feline isolate were included in these studies. Most of these wild-type viruses were grown in rabbit cells. Specifically rabbit-adapted viruses establish persistent infection in immortalized cell lines of various animal species. Brain-, tissue culture-, and cell-free released viruses could all be neutralized with antibodies from naturally and experimentally infected animals (horse; hamster, rat, rabbit, mouse, and chicken), with highest titres in birds. Splenectomized rabbits, which were subsequently infected with BDV, efficiently produced high titres of neutralizing antibodies. All of the neutralizing sera and cerebrospinal fluids from infected animals inhibited tissue culture spread of BDV. Experimental infection and hyperimmunization induced antibodies directed against the major components of the soluble antigen (60, 40/38, 25 and 14.5 kD proteins). Analysis of the s-antigen complex with these sera and 6 stable monoclonal antibodies revealed that it consists of 40/38 and 25 kD proteins. Although each of these antibodies detected intracellular virus-specific structures they did not recognize outer plasma membrane antigens, showed no cross-reactivity, and had no neutralizing capacity. Unifying pathogenetic concepts of this neurotropic virus and its structural elements are discussed.

Solubility of nickel oxide particles in various solutions and rat alveolar macrophages

The solubility of five types of commercial nickel oxide particles was determined in different types of solutions, including distilled water, physiological saline, buffered saline, and tissue-culture medium, in order to estimate their solubility in the human respiratory tract. In addition, we examined the solubility of the two types of particles that were the most and least soluble particles of the above five types of nickel oxide, in rat alveolar macrophages cultured in vitro. The solubility of the nickel oxide particles in these solutions varied remarkably with their types, suggesting that, even though they are called as "nickel oxide," their solubilities are different among the manufacturer and the product lot. Their solubilities were also influenced by the types of solution and the existence of carbon dioxide in the atmosphere. The solubility of nickel oxide particles in the alveolar macrophages was significantly larger than that observed in the culture medium without macrophages, but smaller than that observed in the distilled water. These results suggest that the actual solubility of nickel oxide particles in the respiratory tract may be difficult to estimate by the conventional solubility analysis method using distilled water, and that the enhancement of particle dissolution by the alveolar macrophages and the depression of particle solubility by the coexisting salt and carbon dioxide should be taken into consideration for the accurate estimation.

Spontaneous calcium oscillations and mechanically and chemically induced calcium responses in mammary epithelial cells

Changes of intracellular calcium activity (Ca2+i) in mouse mammary epithelial cells in primary culture (normal) and in an established cell line (MMT060562, cancerous) were investigated by microfluorometry and image analysis of fura-2 fluorescence. In both types of cells, some populations exhibited occasional Ca2+i oscillations with a period of 50-160 s. Slight mechanical stimulation of a cell with a fine glass pipette induced a Ca2+i increase, which spread from the stimulated cell to the surrounding cells with a speed of 7-12 microns/s. ATP (> 1 mumol/l) and ADP, but not AMP induced a Ca2+i increase in both cell types. Bradykinin was highly effective (> 10 nmol/l) only in the cancerous mammary epithelial cells. In Ca(2+)-free solution, all these Ca2+i responses remained unchanged at the first application, and decreased abruptly at the second trial. La3+ (> 0.5 mmol/l) suppressed the response to ATP but not the response to bradykinin. Addition of extracellular Mn2+ rapidly quenched the fura-2 fluorescence in the cell even in a non-stimulated state. Influx of Mn2+ did not increase during Ca2+i responses. These results indicate that the sources of Ca2+i responses in mammary epithelial cells are intracellular stores, which exchange Ca2+ with the extracellular medium.

Lack of linkage between atopy and locus 11q13

Atopy as defined in terms of IgE responsiveness was reported to be controlled by a single gene in British families, and this concept was further supported by a significant linkage between atopy and restriction fragment length polymorphism (RFLP) detected by a DNA probe specific to chromosome 11q13. To confirm this observation in a Japanese population, segregation and linkage analyses were done in four large families. Although segregation patterns of atopy were in agreement with the pattern of autosomal dominant inheritance, there was no significant linkage between atopy and locus 11q13. Alterations in the definitions of atopy did not affect the results. These findings suggested the presence of heterogeneity in genetic elements of atopy, even though atopy may be determined mainly by a single dominant gene.

Cytotoxicity of nickel oxide particles in rat alveolar macrophages cultured in vitro

The cytotoxicity of two types of nickel oxide particles was investigated in rat alveolar macrophages cultured in vitro. The trypan blue dye exclusion test and the release of lactate dehydrogenase into culture medium were used as cytotoxic indices. Although both types of nickel oxide particles were produced by the same manufacturer and were commercially sold under the same name of "nickel oxide", one type of the nickel oxide particles which had black color was much more cytotoxic than the other type of green color. The black nickel oxide particles were more soluble in various kinds of solutions than the green nickel oxide particles. Therefore, it appears that the difference in the cytotoxicity of the black and green nickel oxide particles may be attributable to the difference in the solubility of the particles.

The very low birthweight neonate with an interrupted aortic arch and dextrocardia

Type 1A interruption of the aortic arch complex accompanied by mirror-image dextrocardia with situs inversus was diagnosed by counter-current aortography through the radial artery. This technique is useful for aortography of the very low birthweight neonate.

[Postoperative pain relief by continuous epidural infusion of bupivacaine and buprenorphine]

Continuous postoperative pain relief produced by epidural block with bupivacaine and buprenorphine was evaluated in 12 patients after thoracotomy, 19 patients after upper abdominal surgery, and 14 patients after lower abdominal surgery. Patients initially received 8 ml of 0.25% bupivacaine and 0.1 mg of buprenorphine at recovery room in operating theater and continuously received the mixture of 0.25% bupivacaine and 5 micrograms.ml-1 buprenorphine at a rate of 1 ml.h-1 using a portable pump. About fifty percent of the patients did not need additional narcotics during 48 postoperative hours. About ninety percent of the patients needed one additional narcotics during 48 postoperative hours. The authors conclude that epidural analgesia with the mixture of bupivacaine and buprenorphine produces satisfactory postoperative pain relief.

Study of experimental cervical spondylotic myelopathy

Most cervical spondylotic myelopathy cases show insidious onset. Experimental cervical spondylotic myelopathy models were made using cats to analyze advancing patterns of myelopathy in the spinal cord and to identify the most responsible factor. Spinal cord compression was applied anteriorly using one screw through the C5 vertebral body or three screws through the C4, C5, and C6 vertebral bodies. Every few weeks, the screws were turned approximately 1 mm at a time up to approximately 50% of the spinal canal. At more than 6 months after final compression, limb function and evoked spinal cord potentials were evaluated. Thereafter, histologic examinations were performed.

THE RESULTS

the single compression group showed normal limb function, but the multiple compression group showed sluggish gait. Histologically, mild neuronal decrease in the gray matter was noticeable in the single compression group. Conversely, the multiple compression group showed severe changes in the gray matter and significant changes in the posterior and anterior columns. There was a correlation between the evoked spinal cord potentials and histologic changes. It was clear that multiple compressions to the spinal cord caused more severe deterioration functionally and electrophysiologically as well as histologically than a single compression.

Effusions after anterior cruciate ligament reconstruction using the ligament augmentation device

Persistent effusions occurred in 4.3% (seven patients) of 164 patients who underwent anterior cruciate ligament (ACL) reconstruction using an autograft augmented with the ligament augmentation device (LAD) between 1986 and 1989. No bacteria were cultured from the joint fluid. The radiograph in each case showed a tibial drill hole located anteriorly or anterolaterally. Arthroscopy confirmed an abraded LAD in six cases and breakage of the LAD in one case and impingement of the graft on the femoral condyle during extension. Under polarized light microscopy, the histology of the synovia showed foreign body giant cells in one case and particles among the proliferative cells in four cases. The effusions subsided in two cases after notchplasty and in five cases after removal of the LAD. Impingement of the graft on the femoral condyle due to incorrect positioning of the tibial drill hole presumably produced particles that induced synovitis and effusions.