A computerized method for evaluating balance of occlusal load

In order to undertake a quantitative evaluation of balance occlusal load, the use of the Dental Prescale System was investigated. The method uses a test sheet that undergoes a colour-developing chemical reaction, for detecting contact area, and a computerized analysis system, for evaluating the balance of occlusal load. Twenty natural dentate subjects and 10 hemimaxillectomy patients participated in the study. Each subject bit a test sheet as hard as possible for 3 s. The balance of occlusal load was expressed as a percentage of the load on the side with the lesser occlusive load (%OLR). The %OLR ranged from 39.7% to 49.4% in the natural dentate subjects, and from 0% to 31.3% in the hemimaxillectomy patients at their resection site. The patients' low %OLRs were attributed to loss of sustaining structure and subjective occlusal adjustment by clinicians. Combining technical simplicity, relatively high reproducibility, and diverse analysis capability, this system is useful for quantitative evaluation of balance of occlusal load in clinical situations.

[A case of redo operation for ascending aortic aneurysm after modified Bentall operation for Marfan syndrome associated with type A acute dissecting aortic aneurysm]

A 37-year-old man who had undergone modified Bentall operation in December 1986 had redo operation for ascending aortic aneurysm. Initial operation, in other institute, included aortic root replacement using composite graft and reconstruction of coronary arteries. Left coronary ostium was directly anastomosed to composite graft while a saphenous vein was grafted between composite graft and right coronary artery concomitant with closing right coronary ostium. In addition, composite graft was wrapped with native aortic wall and Cabrol trick was carried out. In December 1994, this patient required redo operation for a 90 mm size of ascending aotric aneurysm which had been used for wrapping in the initial operation. The findings at reoperation revealed patent Cabrol trick, occluded saphenous vein graft, dehiscent proximal anastomosis of saphenous vein graft and partial dehiscence of distal anastomosis of composite graft. The repairs included new saphenous vein grafting to right coronary artery and re-anastomosis of distal site of composite graft. Cabrol trick was closed and composite graft was not wrapped. His post-operative course was excellent and post-operative scintigram indicated ameriolation of inferior wall ischemia.

Progressive degeneration of articular cartilage and intervertebral discs. An experimental study in transgenic mice bearing a type IX collagen mutation

Transgenic mice expressing mutant alpha 1(IX) collagen were produced and found to develop progressive joint degeneration with age, as well as accelerated intervertebral disc degeneration. Radiological and histological studies showed that cervical and lumbar disc degeneration was more advanced in the transgenic mice than in control litter-mates. The changes included shrinkage or disappearance of the nucleus pulposus, and fissures in the annulus fibrosus which sometimes lead to herniation of disc material and slight osteophyte formation. These findings suggest that mutations of the type IX collagen may cause certain forms of degenerative disease in the spine as well as in joints.

Inhibition of testicular germ cell apoptosis and differentiation in mice misexpressing Bcl-2 in spermatogonia

During normal spermatogenesis, more than half of the germ cells undergo apoptosis, but the physiological significance and molecular mechanisms of this programmed cell death are largely unknown. Because Bcl-2 functions as a death repressor, we have investigated the effect of misexpressing Bcl-2 in spermatogonia in transgenic mice using the human bcl-2 cDNA under the control of the human polypeptide chain elongation factor 1alpha (EF-1alpha) promoter. In the 2-week-old transgenic testes, exogenous Bcl-2 was expressed in spermatogonia and massive accumulation of spermatogonia was observed in seminiferous tubules by 4 weeks. At this time, only a few spermatocytes were apparent, and the accumulated cells degenerated, leading to vacuolization in some seminiferous tubules by 7 weeks. In older transgenic mice, abnormal accumulation of spermatogonia and degeneration of these germ cells was still observed, but some seminiferous tubules in which the level of Bcl-2 expression was reduced recovered normal spermatogenesis. These observations indicate that spermatogonial apoptosis is part of the normal program of mammalian spermatogenesis and is regulated by a pathway affected by Bcl-2.

Hepatocyte volume as an indicator of hepatic functional reserve in cirrhotic patients with liver tumours

Using computed tomography (CT), measurements of whole liver volume have been used for the assessment of pre-operative functional reserve in cirrhotics. However, measurements of hepatocyte volume, which exclude stromal fibrous tissue, are considered to more directly reflect hepatic functional reserve. We investigated the relationship between total hepatocyte volume and each of the parameters of conventional liver function. Indocyanine green (ICG) tests and blood analyses for the assessment of liver function were performed prior to surgery in cirrhotic patients with liver tumours. Pre-operative liver volume was determined by integrating images of each liver area obtained by CT. Liver area was measured by an image processing program that traced the profile of the liver image while excluding the tumorous area. Sections of normal tissue stained by the haematoxylin-eosin method, were obtained from the resected liver. Using these sections, a hepatocyte area: whole tissue area ratio was calculated using the image processing program, by tracing the profiles of the hepatocyte nodules. The total volume of hepatocytes was then calculated by multiplying the liver volume by this ratio. The hepatocyte volume per unit bodyweight was significantly correlated with ICG tests and with many other parameters of normal liver function. However, the liver volume per unit bodyweight was correlated only with the plasma ICG disappearance rate and with the blood platelet count. These observations suggest that the functional reserve of the cirrhotic liver is assessed more precisely by hepatocyte volume than by liver volume.

Dominant mutant alleles of yeast protein kinase gene CDC15 suppress the lte1 defect in termination of M phase and genetically interact with CDC14

LTE1 encodes a homolog of GDP-GTP exchange factors for the Ras superfamily and is required at low temperatures for cell cycle progression at the stage of the termination of M phase in Saccharomyces cerevisiae. We isolated extragenic suppressors which suppress the cold sensitivity of lte1 cells and confer a temperature-sensitive phenotype on cells. Cells mutant for the suppressor alone were arrested at telophase at non-permissive temperatures and the terminal phenotype was almost identical to that of lte1 cells at non-permissive temperatures. Genetic analysis revealed that the suppressor is allelic to CDC15, which encodes a protein kinase. The cdc15 mutations thus isolated were recessive with regard to the temperature-sensitive phenotype and were dominant with respect to suppression of lte1. We isolated CDC14 as a low-copy-number suppressor of cdc15-rlt1. CDC14 encodes a phosphotyrosine phosphatase (PTPase) and is essential for termination of M phase. An extra copy of CDC14 suppressed the temperature sensitivity of cdc15-rlt1 cells, but not that of cdc15-1 cells. In addition, some residues that are essential for the CDC14 PTPase activity were found to be non-essential for the suppression. These results strongly indicate that Cdc14 possesses dual functions; PTPase activity is needed for one function but not for the other. We postulate that the cooperative action of Cdc14 and Cdc15 plays an essential role in the termination of M phase.

Yeast src homology region 3 domain-binding proteins involved in bud formation

The yeast protein Bem1p, which bears two src homology region 3 (SH3) domains, is involved in cell polarization. A Rho-type GTPase, Rho3p, is involved in the maintenance of cell polarity for bud formation, and the rho3 defect is suppressed by a high dose of BEM1. Mutational analysis revealed that the second SH3 domain from the NH2 terminus (SH3-2) of Bem1p is important for the functions of Bem1p in bud formation and in the suppression of the rho3 defect. Boi2p, which bound to SH3-2 Bem1p, was identified using the two-hybrid system. Boi2p has a proline-rich sequence that is critical for displaying the Boi2p-Bem1p two-hybrid interaction, an SH3 domain in its NH2-terminal half, and a pleckstrin homology domain in its COOH-terminal half. A BOI2 homologue, BOI1, was identified as a gene whose overexpression inhibited cell growth. Cells overexpressing either BOI1 or BOI2 were arrested as large, round, and unbudded cells, indicating that the Boi proteins affect cell polarization. Genetic analysis revealed that BOI1 and BOI2 are functionally redundant and important for cell growth. delta boi1 delta boi2 cells became large round cells or lysed with buds, displaying defects in bud formation and in the maintenance of cell polarity. Analysis using several truncated versions of BOI2 revealed that the COOH-terminal half, which contains the pleckstrin homology domain is essential for the function of Boi2p in cell growth, while the NH2-terminal half is not, and the NH2-terminal half might be required for modulating the function of Bem1p. Overproduction of either Rho3p or the Rho3p-related GTPase Rho4p suppressed the boi defect. These results demonstrate that Rho3p GTPases and Boi proteins function in the maintenance of cell polarity for bud formation.

[Successful surgical repair of acute DeBakey type I aortic dissection complicated by acute occlusion of the suprarenal abdominal aorta]

We reported a case of acute DeBakey type I aortic dissection presented with occlusion of the suprarenal abdominal aorta, who was successfully treated by simultaneous graft replacement of the ascending aorta and total aortic arch. The patient was a 68-year-old man who complained of chest pain and symptoms of acute arterial occlusion of bilateral lower extremities, and who had consciousness disturbance due to stroke caused by aortic dissection. He underwent simultaneous graft replacement of the ascending aorta and total aortic arch under selective cerebral perfusion during an emergent operation. For reconstruction of the arch vessels, we used three separate grafts that were connected to the aortic prosthesis before use. Although postoperative course was complicated by myonephropathic metabolic syndrome, the patient subsequently recovered and was discharged on foot. Early vascular reconstruction and appropriate management of reperfusion injury are extremely important in the setting of malperfusion phenomena complicating acute aortic dissection.

Differences between 99mTc-DTPA and 99mTc-MAG3 captopril renographies in renovascular hypertension

Captopril renography (CRS) with 99mTc-DTPA and 99mTc-MAG3 was performed on a 21-year-old woman with renovascular hypertension due to right renal artery stenosis caused by fibromuscular dysplasia. In the affected kidney, the renogram pattern was substantially changed with 99mTc-DTPA and 99mTc-MAG3 following the administration of captopril, and the quantitated renal uptake indicating individual renal function was significantly decreased in 99mTc-DTPA and slightly decreased in 99mTc-MAG3. In the contralateral normal kidney, the renogram showed some minor changes with both radioagents, while the quantitated renal uptake was significantly decreased with 99mTc-DTPA and substantially increased with 99mTc-MAG3. The combined use of physiologically different renal agents 99mTc-DTPA and 99mTc-MAG3 is helpful in investigating hemodynamic and functional changes in the stenosed kidney as well as the normal kidney in RVH.

The evaluation of masticatory function with low adhesive colour-developing chewing gum

Many objective methods have been described to evaluate masticatory function. Recently, a new chewing gum system has been reported that utilizes a phloxine-sodium bicarbonate reaction and measures a chromatic coordinate as a functional indicator. A low-adhesive colour-developing chewing gum has been developed by selecting an appropriate gum base. This study examined the applicability of the system and reproducibility of results in subjects with different dental states. Tests were performed on 15 natural dentate subjects and 15 complete denture wearers after determination of germane test conditions through a pilot study. The colour was measured by a*, one of the coordinates in the L*a*b* colour system. All subjects could perform the test. The coefficient of variation ranged from 1.87% to 7.90%, averaging 5.15% in the natural dentate subjects and from 1.5% to 17.9%, averaging 9.75% in the complete denture wearers. The 95% confidence interval of a* was 28.76 +/- 1.76 in the natural dentate subjects and 10.05 +/- 2.58 in the complete denture wearers. The results indicated that this material can be useful for both complete denture wearers and subjects with a natural dentition with adequate reproducibility.

[Dissection of the interventricular septum with aorto-left ventricular communication due to infective endocarditis--report of a rare case]

Dissection of the interventricular septum is an uncommon manifestation, which is rarely associated with infective endocarditis, aneurysm of sinus of Valsalva and thoracic trauma. We report a 34-year-old male case with aorto-left ventricular communication due to infective endocarditis. The patient had chief complaints of dyspnea on exertion and precordial discomfort. Preoperative laboratory data showed normal white blood cell counts, a slightly elevated CRP, and negative blood culture in bacterial examinations. Echocardiogram revealed progressive dissection of the interventricular septum and stenosis of the left ventricular outflow tract. Disturbance of conduction including progressive atrioventricular block and bundle branch block were found in the electrocardiogram. The dissection extended over 2 x 2 x 2.5 cm in diameter, with an entry located at the basis of the right coronary cusp and reentry communicated to the left ventricle. Operative procedures included the aortic valve replacement with prosthetic valve due to severe inflammation, in addition to resection of the dissecting cavity. Pathological examination of the resected tissue accorded with infective endocarditis in active phase, showing necrosis, small cell infiltration and microabscess. However, a bacterial colony was not found in the surgical specimen. Postoperative course was uneventful and the patient was discharged in satisfactory conditions.

[Successful aorto-coronary bypass grafting and concomitant left ventricular myotomy-myectomy in a patient with coronary artery disease associated with hypertrophic obstructive cardiomyopathy]

A 65-year-old man complained chest oppression at rest and dizziness. Echocardiography showed subaortic stenosis with outflow gradient of 100 mmHg, although interventricular septal thickness was only 12 mm and left ventricular posterior wall thickness was 11 mm, and mild mitral regurgitation. Selective coronary angiography demonstrated 90% stenosis in left main truncus, 50% stenosis in first diagonal branch, and hypoplastic right coronary artery. Emergent coronary artery revasculization concomitant with left ventricular myotomy myectomy was performed. Immediately after weaning off the cardiopulmonary pump, IABP was employed for cardiac assistance, because of residual left ventricular outflow pressure gradient, which was provoked by cathecholamine and amyl nitrite. He was discharged in 1 month in NYHA class I. Echocardiography 3 months after operation showed no residual outflow pressure gradient, no systolic anterior motion of mitral anterior leaflet, and mild approximately mitral regurgitation. Careful operative management, including myocardial protection and avoiding perforation of ventricular septum and postoperative medical care are mandatory to this group of patients. This case is the first successful coronary artery bypass grafting and concomitant left ventricular myotomy-myectomy reported in Japan.

Masticatory function of postoperative tumor patients rehabilitated with osseointegrated implants

PURPOSE

This study determined the level of masticatory function that can be achieved with osseointegrated implants in postoperative tumor patients.

PATIENTS AND METHODS

Masticatory function was evaluated in 15 postoperative tumor patients with implants, 22 nontumor patients with implants, and 15 natural dentate controls. The area of occlusal contact was evaluated with a pressure-sensitive, color-developing bite sheet analyzed by computer. Chewing performance was evaluated by a low-adhesive, color-developing, chewing-gum system.

RESULTS

Subjects in the tumor group had load-bearing tooth contacts similar to those of the natural dentate controls and nontumor implant patients. Continuity of the mandible was essential to sustain occlusal load. The presence of the hypoglossal nerve was the main factor in determining restoration of chewing performance.

CONCLUSIONS

Surgical efforts to preserve the mobility of the residual tongue and prosthetic approaches to restore impaired mobility to as great an extent as possible are especially important for better functional rehabilitation of patients who have defects of the hypoglossal nerve.

Regulation of energy metabolism by interleukin-1beta, but not by interleukin-6, is mediated by nitric oxide in primary cultured rat hepatocytes

The effects of inflammatory cytokines (interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha) on energy metabolism were studied in primary cultured rat hepatocytes. Adenine nucleotide (ATP, ADP, and AMP) content, lactate production, the ketone body ratio (acetoacetate/beta-hydroxybutyrate) reflecting the liver mitochondrial redox state (NAD+/NADH), and nitric oxide formation were measured. Insulin increased ATP content in hepatocytes and had a maximal effect after 8-12 h of culture. Both interleukin-1beta and interleukin-6, but not tumor necrosis factor-alpha, significantly inhibited the ATP increase time- and dose-dependently. Interleukin-1beta and interleukin-6 also stimulated lactate production. During the same period, interleukin-1beta but not interleukin-6 decreased the ketone body ratio. Furthermore, interleukin-1beta markedly stimulated nitric oxide formation in hepatocytes, and this increase was blocked by NG-monomethyl-L-arginine (a nitric oxide synthase inhibitor) and by interleukin-1 receptor antagonist. NG-monomethyl-L-arginine reversed inhibition of the ATP increase, decrease in the ketone body ratio, and increase in lactate production, which were induced by interleukin-1beta. Interleukin-1 receptor antagonist completely abolished all of the effects induced by interleukin-1beta. These results demonstrated that interleukin-1beta and interleukin-6 affect the insulin-induced energy metabolism in rat hepatocytes by different mechanisms. Specifically, interleukin-1beta inhibits ATP synthesis by causing the mitochondrial dysfunction, a process which may be mediated by nitric oxide.

Genetic analysis of the Saccharomyces cerevisiae RHO3 gene, encoding a rho-type small GTPase, provides evidence for a role in bud formation

RHO3 encodes a Rho-type small GTPase of the yeast Saccharomyces cerevisiae. We isolated temperature-sensitive alleles and a dominant active allele of RHO3. Ts- rho3 cells lost cell polarity during bud formation and grew more isotropically than wild-type cells at nonpermissive temperatures. In contrast, cells carrying a dominant active mutant RHO3 displayed cold sensitivity, and the cells became elongated and bent, often at the position where actin patches were concentrated. These phenotypes of the rho3 mutants strongly suggest that RHO3 is involved in directing the growing points during bud formation. In addition, we found that SRO6, previously isolated as a multicopy suppressor of rho3, is the same as SEC4. The sec4-2 mutation was synthetic lethal with temperature-sensitive rho3 mutations and suppressed the cold sensitivity caused by a dominant active mutant RHO3. The genetic interactions between RHO3 and SEC4, taken together with the fact that the Rab-type GTPase Sec4p is required to fuse secretory vesicles together with plasma membrane for exocytosis, support a model in which the Rho3p pathway modulates morphogenesis during bud growth via directing organization of the actin cytoskeleton and the position of the secretory machinery for exocytosis.

Maternal allergen stimulation suppressed respiratory allergy in offspring: with special reference to allergy related cells in the tonsil

Pregnant mice and Hartley guinea pigs were immunized with T dependent antigen, heterologous erythrocyte and ovalbumin (OVA), and the active immune responsiveness as well as the allergic symptoms of the offspring were investigated. Guinea pigs were also sensitized to OVA intraperitoneally and subcutaneously with a 100 mg/ml solution of saline containing 5 mg of AI(OH)(3) as an adjuvant. Six weeks after the initial allergen stimulation, systemic and local anaphylaxis as elicited by 1-min aerosol administration of a nebulizer and monitored by macroscopic vision accompanied by a time trial for respiratory and cardiac arrest. Serum antibody levels were tested by passive hemagglutination as well as passive cutaneous anaphylaxis especially for the estimation of IgE levels. Nasal, tonsillar and bronchial tissues were also prepared and fixed, followed by hematoxylin and eosin staining for histological observation. In the offspring of mothers who had been stimulated with optimal amounts of the allergen and had fully developed specific antibodies against the allergen, there was a clear-cut suppression in the development of a specific respiratory allergy over a significant period after delivery. The effect was confirmed by systemic and local anaphylaxis, eosinophil infiltration, ciliary deformation in nasal mucosae and the tonsillar site in the complex interaction of various cell types and mediators eliciting the clinical respiratory symptoms, in particular nasal hypersensitivity. In a different experimental model, the mouse model, these biological findings were not regulated by maternal transferable antibody or antigen fragments from the mother. The induction of suppressor T cell (CD(4+)) in offspring depends on the recognition of the antigens presented in association with the same MHC haplotype as that utilized in the maternal T cell response during pregnancy. These results suggest the presence of suppression mechanisms in the offspring of mothers stimulated during pregnancy. From these results, we discuss the mechanisms for suppression and protective efficacy for respiratory allergy as well as possible side effects in the young of mothers stimulated during pregnancy.

A computerized method for evaluating distribution of occlusal load on implant-supported fixed cantilever prostheses

An investigation was conducted to determine whether Dental Prescale, a material that undergoes a graded color-producing chemical reaction when force is applied, could be used to evaluate occlusal load distribution objectively and quantitatively when combined with computer analysis. Ten patients with an implant-supported fixed cantilever prosthesis and a complete conventional maxillary denture were studied. The results indicated that the system can be used to evaluate occlusal load distribution with sufficient reproducibility. However, in its present form, the system is somewhat cumbersome, and its use must now be considered experimental. Further refinement is necessary to allow easier clinical use.

Congenital stationary nightblindness in a patient with osteopetrosis

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Preoperative disseminated intravascular coagulation (DIC) associated with aortic aneurysm--does it need to be corrected before surgery?

Disseminated intravascular coagulation (DIC) is one of the complications accompanying aortic aneurysm. We herein report four patients with aortic aneurysm who had DIC preoperatively. In all four cases, DIC was corrected immediately after surgery; however, in two cases, DIC could not be corrected preoperatively. This prompted us to reconsider the importance of correcting DIC before surgery. Of the four cases reported in this paper, DIC existed even at the time of surgery in two cases, in spite of meticulous treatment with heparin and/or protease inhibitor; however, the DIC could be removed postoperatively even in these two cases. Surgeons should not waste time with intensive DIC treatment preoperatively. If the DIC cannot be corrected within more than 2 weeks of meticulous treatment, surgeons should then perform surgery on the patient. In addition, it is also essential to ensure that the DIC is due to the aneurysm itself and that no other disease processes have been overlooked.

Seronegative myasthenia gravis associated with atonic urinary bladder and accommodative insufficiency

We report a 20-year-old female with generalized myasthenia gravis (MG) who developed atonic urinary bladder and accommodative insufficiency. Although her sera did not contain antibodies to either nicotinic acetylcholine receptor (AChR) or voltage-gated calcium channels, a positive intravenous edrophonium test and a waning phenomenon on electromyographic studies indicated a diagnosis of seronegative MG. Myasthenic symptoms as well as urinary incontinence and impaired near vision disappeared with slight sequelae after corticosteroid therapy and total removal of the hyperplastic thymus. These symptoms recurred during a tapering course of corticosteroids, and improved again with an increased dose. Therefore, in this patient, the neuromuscular transmission of muscarinic type of AChR in the smooth muscles was also affected. This patient provides insight into the mechanisms by which some smooth muscles are involved in MG.