Suitable location and optimum bladder width for the occluding cuff used for indirect arterial blood pressure measurements at the wrist

Using a finite element method (FEM) and a volume oscillometric method with a photo-electric plethysmograph, we tried to determine which location(s) and which bladder width(s) of the occluding cuff would allow the most accurate indirect blood pressure measurements at the human wrist. Nuclear magnetic resonance imaging of the wrist allowed us to determine the geometry of two-dimensional (2D) finite element models. FEM analysis showed that the pressure transmission ratio (calculated tissue pressure: externally applied pressure) from the cuff to the radial artery (RA) was 100% when the cuff was placed over the site (L1) at which the RA crosses the most protuberant spot on the volar aspect of the distal end of the radius. In fact, the mean blood pressure (BPM) measured at this site in human subjects coincided with that measured at the upper arm (BPMA). In addition, a three-dimensional (3D) FEM was constructed by extending the 2D FEM at site L1 in the longitudinal direction to investigate the relation between pressure transmission to the RA and cuff bladder width. FEM analysis using the 3D finite element model showed that for all cuff widths greater than 0.25 times the diameter of the wrist, the external pressure was transmitted almost completely to the RA beneath the cuff center. Moreover, when the cuff width was as large as 0.45 times the diameter of the wrist, the BPM measured at site L1 in human subjects was similar to the BPMA. The theoretical and experimental results in the present study both suggest that for accurate indirect blood pressure measurements at the wrist, the L1 site is a suitable location for the occluding cuff and a cuff whose bladder width is more than one-third but less than one-half the wrist diameter can be used.

Nontraumatic bilateral first rib fractures

The authors report the case of a 21-year old woman who presented bilateral spontaneous fractures of the first ribs, in the posterior portion on the right side, in the anterior portion on the left side. The pathogenesis of spontaneous fractures of the first rib is discussed.

Polyethylene wear from femoral bipolar neck-cup impingement as a cause of femoral prosthetic loosening

A 33-year-old woman underwent an uncemented bipolar hip arthroplasty for osteoarthrosis of the left hip in 1985. Because of painful aseptic loosening, the bipolar implant was revised to a total hip prosthesis in 1994. Membranous tissues around the implant histologically presented foreign-body reaction against polyethylene debris. The retrieved implant showed polyethylene wear of the rim of the bipolar cup. Three-dimensional measurement of the surface configuration of the polyethylene of the cup indicated that wear debris had been generated almost exclusively from femoral bipolar neck-cup impingement. Volumetric wear in the articulating dome portion of the polyethylene was negligible. This report clearly illustrates how impingement of a bipolar cup on the femoral neck can be a major source of polyethylene wear debris which induces femoral osteolysis and subsequent stem loosening.

Cloning and expression of pigeon growth hormone receptor cDNA in COS-7 monkey kidney cells

Pigeon growth hormone receptor (pGHR) cDNA has been cloned, sequenced, characterized and expressed in COS-7 cells. The predicted pGHR preprotein was composed of 611 amino acids and contained a putative signal peptide, a single transmembrane region and the conserved proline-rich box 1 domain in the cytoplasmic region. A canonical polyadenylation signal was found in the extracellular region, as was observed in chicken growth hormone receptor cDNA. Northern blot analysis identified a single species of pGHR mRNA and its expression was widely observed in tissues in the young male pigeon. A pGHR expression vector was constructed and transfected into COS-7 cells. The transfected cells were specifically bound by 125I-labeled chicken GH and the binding was suppressed by the addition of excess amounts of unlabeled chicken GH.

Thyroid hormones are involved in insulin-like growth factor-I (IGF-I) production by stimulating hepatic growth hormone receptor (GHR) gene expression in the chicken

Effect of thyroid status on IGF-I production in growing chickens was studied. Serum concentrations of GH were not affected by propylthiouracil (PTU) or thyroxine (T4) treatments, whereas serum IGF-I levels were significantly decreased in PTU-treated chickens. The lowered serum IGF-I levels in the PTU-treated group were completely restored to the control levels by T4 injections. In the liver, the messenger RNA (mRNA) expressions both for GH receptor (GHR) and IGF-I were significantly repressed by PTU treatment, and were restored again by T4 replacement. In addition, the results of analysis on radiolabelled GH binding to the liver membrane were consistent with the levels of hepatic GHR mRNA expression. Serum concentrations of IGF-I were positively correlated with hepatic IGF-I mRNA and GHR mRNA expressions. The correlation coefficient between serum T3 levels and hepatic IGF-I mRNA expressions was also significant. These results indicate that thyroid hormones regulate IGF-I production in the chicken by affecting hepatic GHR expression.

[Simultaneous rupture of multiple intracranial aneurysms: a case report]

A rare case of simultaneous rupture of multiple aneurysms is reported. A 68-year-old man presented severe headache and vomiting and was transferred to our hospital. CT scan showed subarachnoid hemorrhage (SAH) in the interhemispheric fissure, the right basal cistern, the right sylvian fissure and intracerebral hemorrhage (ICH) in the paraventricle area. Continuation of the hemorrhage could not be detected between SAH and ICH on CT scan. Multiple aneurysms were detected by angiograms on the anterior communicating artery (A-com) and the bifurcation and the distal portion of the left middle cerebral artery (MCA). These findings suggested that SAH was due to a ruptured aneurysm of A-com, and ICH was due to a ruptured aneurysm of the distal portion of MCA. Simultaneous rupture of multiple aneurysms was confirmed by surgical findings. This case indicates that the usual assumption of a single aneurysm rupture in a patient with multiple aneurysms may be erroneous.

Cerebral gumma mimicking glioblastoma on magnetic resonance images--case report

A 39-year-old female presented with a syphilitic cerebral gumma mimicking small glioblastoma multiforme manifesting as visual impairment. Magnetic resonance imaging showed a low signal intensity area on T1-weighted images and marked small ring-like enhancement less than 1 cm in diameter following the administration of gadolinium. The symptoms and radiological abnormalities improved several weeks after penicillin therapy. The small ring-like enhancement was probably caused by inflammation associated with treponemal infection. A mass with a small ring-like enhancement less than 1 cm in diameter is a useful finding indicating an inflammatory lesion rather than a glial tumor.

Intrasyringal hemorrhage of the cervical cord associated with Chiari type I malformation--case report

A 34-year-old male presented with intrasyringal hemorrhage associated with Chiari type I malformation manifesting as a history of repetitive severe pain around his neck and back and progressive sensory disturbance. Magnetic resonance imaging clearly demonstrated syringomyelia at the cervical region associated with Chiari type I malformation and hemorrhage in the syrinx which was strongly suggestive of bleeding into pre-existing syringomyelia or Gowers' syringal hemorrhage. Irrigation of the syrinx and syringosubarachnoid shunting were performed, but rebleeding occurred causing shunt malfunction. Shunt revision was performed, but a new cavity developed above the original syrinx. Foramen magnum decompression resulted in successful reduction of the new syrinx and subsequent neurological improvement. Simultaneous foramen magnum decompression and syrinx irrigation may be a better approach to treat this disease.

Effects of acidic fibroblast growth factor on neuronal activity of the parvocellular part in rat paraventricular nucleus

The effects of acidic fibroblast growth factor (aFGF) and its amino-terminal and carboxyl-terminal fragments (aFGF(1-15) and aFGF(114-140), respectively were examined on the neuronal activity in the parvocellular part of the paraventricular nucleus. As well known, this part contains a lot of corticotropin-releasing factor (CRF)-immunoreactive neurons. Application of 1 pg/ml and 2 pg/ml aFGF produced responses in 29.7% and 46.7% of neurons tested, respectively. Half or more than half of the responding neurons increased their discharge rate. Application of 0.2 ng/ml and 0.4 ng/ml aFGF(1-15) (1-15) also elicited response in 46.2% and 68.8% of neurons tested, respectively. Of these responding neurons, more than two third increased their firing rate. However, most of neurons tested for 0.67 ng/ml and 1.33 ng/ml aFGF(114-140) did not respond. Results suggest that aFGF and aFGF(1-15) promote the release of CRF through the activation of CRF-containing neurons.

Successful reconstruction for combined tracheal and bronchial disruption

After a head-on automobile collision, a 21-year-old man was admitted with respiratory distress and subcutaneous emphysema. Bronchoscopy revealed a disruption of the trachea and a complete transection of the intermediate bronchus. A right posterolateral thoracotomy was performed, and both lesions were reconstructed primarily using absorbable materials.

Portable digital subtraction angiography in the operating room and intensive care unit

A simple, inexpensive method of portable digital subtraction angiography (DSA) using an image processor (Sigma X), still-videorecorder and control panel combined with a surgical x-ray television unit can provide real time subtraction images on the monitor. This portable DSA unit was used in 161 cases (130 in the operating room and 31 in the intensive care unit). In the operating room it is useful: 1) to confirm patency of the parent artery and its branches after aneurysm clipping, 2) to identify feeding arteries of arteriovenous malformation and to confirm total extirpation, 3) to confirm the patency of extracranial-intracranial bypass, 4) to confirm patency of the internal carotid artery and absence of flap formation after carotid endarterectomy. In the intensive care unit, it is particularly useful for visualizing cerebral vasospasm after subarachnoid hemorrhage and recanalization of an occluded major intracranial artery. Absence of intracranial circulation can be demonstrated in patients with suspected brain death.

Radiolucent osteoma of the skull: case report

A rare case of a radiolucent osteoma of the skull is reported. The radiological and pathological findings of this lesion, including magnetic resonance imaging findings, are presented, and the efficacy of magnetic resonance imaging for the diagnosis of this skull tumor is evaluated. The differential diagnosis of radiolucent bone tumors is discussed.

[Intraoperative evaluation of carotid endarterectomy with electromagnetic flowmetry and portable DSA]

In order to perform carotid endarterectomy more safely, we have evaluated, intraoperatively, the result of an operation with electromagnetic flowmeter and portable digital subtraction angiography (DSA). During surgery, flow of the exposed internal and common carotid artery was measured with an electromagnetic flowmeter, before and after endarterectomy. After the closure of the arteriotomy, portable DSA was carried out by injecting contrast medium from the common carotid artery. Our simple portable DSA system consists of a surgical X-ray television set, image processor (Sigma X) and still video-recorder. This system almost gives us a real-time presentation of a subtracted view of angiography. There were twenty patients including one patient with major stroke, 14 with minor stroke, three with transient ischemic attack, and two asymptomatic patients. Increase of the flow through the internal carotid artery was documented with an electromagnetic flow-meter in 13 of 20 patients following endarterectomy. Flow reduction was seen in two patients, one of whom was found to have an intimal flap from residual plaque visualized in the portable DSA. The plaque was removed by reopening the artery. Among twenty patients, intraoperative portable DSA showed an intimal flap in three patients and a step in four patients. Although the incidence of abnormal findings was high, degree of abnormality was not severe enough to reopen the artery except in one case. The purposes of carotid endarterectomy is two-fold. It is used for the removal of the plaques which can be a source of emboli, and also for the augmentation of flow in the narrowed segment of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Histological study of the oral mucosa of PSS]

Histological examination was performed on the oral mucosa of 25 patients with PSS which consisted of 16 cases of Acrosclerotic type (A type) and 9 cases of Diffuse type (D type). Results obtained were as follows: (A) Sclerotic change of connective tissue were found in the submucosal area (a type) and in the salivary peri-glandular++ area (b type) and also in the both areas (c type). (1) In A type of PSS, sclerotic changes was found in 14 out of 16 cases (87.5%) and (2) In D type, 9 out of 9 cases (100%). (3) In D type, sclerotic changes were marked and, moreover, found in the earlier stage of disease more than in A type. (B) Inflammatory change of salivary gland based on the criteria of Chisholm and Mason. (1) Moderate and marked salivary gland adenitis were found in 6 out of 16 cases of A type (37.5%) and 2 out of 9 cases of D type (22%). (2) Adenitis were found more frequently in the early stage of disease in both types. From above described findings, it is concluded that 1) as to sclerotic change, the early and marked changes were found in D type and 2) as to inflammation of salivary gland, no significant difference was found between both types.

[Barbiturate therapy in traumatic cerebral vascular disease: report of two cases]

We report two cases of traumatic cerebral vascular disease which were treated successfully with barbiturate. The first case sustained blunt trauma to the bilateral vertebral arteries, resulting in complete occlusion of both arteries. After ligation of the injured vertebral arteries, multiple cerebral infarction appeared. Cerebral angiography revealed dissection and stenosis of the bilateral internal carotid arteries. We treated this case with barbiturate (Thiamylal) in combination with administration of heparin. The second case sustained cerebral contusion and traumatic subarachnoidal hemorrhage as a result of a motor cycle accident. This patient deteriorated and cerebral angiography showed diffuse cerebral arterial vasospasms. When this was treated with induced hypertension, he developed recurrent subarachnoid hemorrhage. In order to protect the brain from ischemia without elevating blood pressure, we employed barbiturate therapy and the patient recovered without major neurological deficit. The condition of severe head injury with cerebral ischemia is complicated. Therefore it has been hard for neurosurgeons to cure the patient with this condition. But we treated it with barbiturate successfully. Barbiturate therapy in severe head injury with cerebral ischemia may decrease the mortality in that group of patients considered difficult to treat with the usual therapeutic modalities.

A rapid electrophoretic method for the detection of serum Lp(a) lipoprotein

A rapid electrophoretic method detecting serum lipoprotein(a) (Lp(a)) was described. When serum lipoproteins were electrophoresed using an agarose gel film containing 0.6% agarose and 3% sucrose, a distinct extra-band was frequently detected between beta- and prebeta-bands. This lipoprotein band was identified as Lp(a) by immunoblotting technique using anti-Lp(a) serum. Using this electrophoretic method, we studied 1,353 subjects with a variety of diseases. The Lp(a)-positive subjects accounted for 8.4% of all. Neither sex nor age influenced the frequency of Lp(a) positivity. Frequencies of definite myocardial infarction in Lp(a)-positive subjects did not differ significantly from those in Lp(a)-negative ones. Those of cerebral infarction in Lp(a)-positive subjects were significantly higher than those in Lp(a)-negative ones. An electrophoretic method described herein is very useful for the rapid detection and screening of Lp(a), and hence for large-scale clinical studies of atherosclerotic risk assessment.

Cloning of the cellulase gene from Ruminococcus albus and its expression in Escherichia coli

The gene for cellulase from Ruminococcus albus F-40 was cloned in Escherichia coli HB101 with pBR322. A 3.4-kilobase-pair HindIII fragment encoding cellulase hybridized with the chromosomal DNA of R. albus. The Ouchterlony double-fusion test gave a single precipitation line between the cloned enzyme and the cellulase from R. albus. The size of the cloned fragment was reduced by using HindIII and EcoRI. The resulting active fragment had a size of 1.9 kilobase pairs; and the restriction sites EcoRI, BamHI, PvuII, EcoRI, PvuII, and HindIII, in that order, were ligated into pUC19 at the EcoRI and HindIII sites (pURA1). Cellulase production by E. coli JM103(pURA1) in Luria-Bertani broth was remarkably enhanced, up to approximately 80 times, by controlling the pH at 6.5 and by reducing the concentration of NaCl in the broth to 80 mM.

[Functional and morphological analysis on GH producing adenomas with quantitative immunohistochemical method]

We studied functioning cells of GH-producing pituitary adenoma quantitatively by the immunohistochemical method using anti GH antibody and compared the result with clinical hormonal data by discussing a clinical significance of the immunohistochemical study of pituitary adenoma. Fifteen acromegalics with pituitary adenoma, who underwent surgical operation followed by immunohistochemical study, were subjected. Volume of the adenoma was calculated on the basis of thin coronal cut CT scanning. The specimen was stained after PAP method. The quantitative analysis was done by investigating the ratio of anti GH antibody positive area in 30 fields (SAR). Using the value obtained, stained volume (SV) was calculated by multiplying total volume by SAR. The SV was regarded as total volume of GH positive cells. These values were compared to the preoperative serum GH levels. The results were as follows: (1) Immunohistochemically, the adenomas were classified into two types, the sporadic type and the diffuse type, by incidence of GH positive cells. SAR ranged from 0.2% to 52.4%, and means of the types were 3.0% and 24.8%, respectively. (2) All the eosinophilic adenomas demonstrated to be the diffuse type and the mean SAR was 23.7%. On the contrary, 75% of chromophobe adenomas were the sporadic type and the mean SAR was 4.9%. (3) There was no significant correlation between the serum GH level and the volume of the adenoma. There was an especially high correlation between the serum GH level and SV with a correlation constant of 0.971. (4) In fibrous adenomas the serum GH level was extremely low for their total volume.

[Investigational study of various kinds of problems in heating methods. Regarding equipment. The BSD-1000 hyperthermia system]

The BSD-1000 Hyperthermia System delivers therapeutic heat (hyperthermia) to surface or subsurface and deep seated malignant tumors by the external or interstitial application of electromagnetic energy, and monitors the temperature of target and surrounding tissues by means of invasive temperature probes. In response to an operator-designated control probe, the BSD-1000 Hyperthermia System automatically adjusts power to maintain the operator-set therapeutic temperature. Characterization was described according to the following items mainly based on home data, heating ability temperature measurement environmental effects by the electromagnetic field 4) practical problems. It is important to submit materials so that users could judge which equipments would suit their own purposes. In order to standardize how to express the efficiency in each equipment, collaboration is stressed in every concerned field.

[Malignant meningioma with extracranial metastasis]

We report case of malignant meningioma involving the lumbar vertebra (3rd and 4th). A 53-year-old man who developed occipitalgia in April 1977 was operated under the diagnosis of posterior fossa tumor in August 1977. The tumor was totally removed macroscopically Simpson grade 2. The histological diagnosis was malignant meningioma, He complained of lumbago and right leg pain since June 1981. Destruction and tumor stain of the 3rd and 4th lumbar vertebrae were recognized on CT scans. In May 1982, surgical decompression and spinal fixation were attempted. The surgical specimen was verified as a malignant meningioma. Therefore, he underwent irradiation therapy to the lumbar spine (total dose 50 Gray). He presented with occipitalgia in March 1983. CT scan detected tumor recurrence in the suboccipital region. The recurrent tumor was totally removed immediately. The histological feature was malignant meningioma. The mode and site of metastasizing meningioma are discussed with a review of the literature.