Four-year follow-up study of temporomandibular joint arthroscopic surgery for advanced stage internal derangements

PURPOSE

This study evaluated the long-term outcome after temporomandibular joint (TMJ) arthroscopic surgery for patients with internal derangement with stage V disease.

MATERIALS AND METHODS

Fifteen female patients (24 TMJs) who underwent arthroscopic surgery were evaluated by a questionnaire preoperatively and postoperatively 3 to 5 years later (mean: 4 years, 2 months). The questionnaires consisted of a visual analog scale, pain and jaw dysfunction scores, and self-measured interincisal opening. Clinical examination and conventional radiographic evaluation were done in nine patients (13 joints). Postoperative magnetic resonance imaging was done in two patients (3 joints).

RESULTS

All post-treatment scores showed a statistically significant improvement, although joint noise remained in some patients. The radiographic examination revealed mild to moderate degenerative changes, but no abnormal resorption was detected. The surgical success rate was 93.3%.

CONCLUSION

Arthroscopic surgery is a useful, minimal invasive, surgical procedure for advanced stage internal derangement of the TMJ.

Endothelin ETA and ETB receptors mediate endothelin-1-induced apamin-sensitive relaxation in the guinea pig ileum

Endothelin (ET) receptors involved in ET-1-induced responses of the longitudinal muscle of the isolated guinea pig ileum were studied. ET-1 caused concentration-dependent contractions, while ET-3 and selective ETB-receptor agonists, IRL1620 and sarafotoxin 6c (S6c), showed little or no effect. The ET-1-induced contractions were antagonized by BQ-123, an ETA-receptor antagonist, or PD142893, an ETA/ETB-receptor antagonist, indicating that the contraction is mediated by the ETA receptor. In preparations precontracted with carbachol, ET-1 elicited relaxations at lower concentrations and contractions at higher concentrations. ET-3, IRL1620 and S6c caused relaxations. These relaxations were little affected by BQ-123, but greatly antagonized by PD142893. The ET-1-induced relaxations were slightly affected by BQ-788, an ETB-receptor antagonist, but were markedly inhibited by the combination of BQ-788 and BQ-123. In ETB receptor-desensitized preparations, ET-1-induced relaxations were antagonized by BQ-123, whereas ET-3, S6c and IRL1620 showed no response. All these relaxations were abolished by apamin. These results indicate that ETA and ETB receptors mediate relaxation of the ileal smooth muscle through activation of apamin-sensitive K+ channels.

Synthesis and biological activity of the metabolites of diethyl 4-[(4-bromo-2-cyanophenyl)carbamoyl]benzylphosphonate (NO-1886)

Five metabolites of diethyl 4-[(4-bromo-2-cyanophenyl)carbamoyl]benzylphosphonate (NO-1886) (1) were synthesized to confirm their proposed structures. The metabolites (2-6) were found to be identical with the synthesized compounds. These metabolites were orally administered to Triton WR-1339-induced hypertriglyceridemic rats, and the plasma levels of triglycerides were measured to estimate lipoprotein lipase activity. All the metabolites showed lower potency than NO-1886.

Plasma endothelin-1 level in athletes after exercise in a hot environment: exercise-induced dehydration contributes to increases in plasma endothelin-1

We investigated whether dehydration due to exercise contributes to the increase in plasma endothelin-1 (ET-1) concentration. We measured the plasma concentration of ET-1 before and after exercise in a hot environment (about 30 degrees C). Five male intercollegiate Kendo (Japanese fencing) players entered the present study. Each athlete participated in 15 min of Kendo fighting, followed by 5 min of rest and another 15 min of Kendo fighting (i.e., total exercise 30 min), with or without oral intake of 700 ml of water. Body weight and left atrial diameter, a parameter that reflects changes in circulating plasma volume, were significantly decreased after exercise under both conditions. However, the decreases in both values were significantly greater after exercise without water intake than after exercise with water intake, indicating that dehydration and decreased circulating plasma volume were more marked after exercise without water intake. The extent of the increase in plasma ET-1 concentration appeared to be closely related to the extent of exercise-induced dehydration; the greater the dehydration, the greater the increase in plasma ET-1 concentration. These findings suggest that exercise-induced dehydration may contribute to increases in plasma ET-1 concentrations.

Examination of the safety of intracytoplasmic injection procedures by using bovine zygotes

We have evaluated the safety of intracytoplasmic sperm injection(ICSI) procedures by using bovine zygotes. Bovine zygotes were injected with a small amount (2-3 pl) of either medium alone or medium containing polyvinylpyrrolidone (PVP) (sham-ICSI, without spermatozoon) using the same procedure as ICSI, and the subsequent in-vitro embryonic development and embryo quality (number of cells/blastocyst) were examined. Control zygotes which had not been injected were similarly evaluated after in-vitro development. The sham-ICSI of either medium alone or medium containing PVP into bovine zygotes had no harmful effects on the rate of normal fertilization and on the rate of development to hatched blastocyst stage compared with those of controls (P > 0.05). In addition, no harmful effects were observed in the number of cells per blastocyst (embryo quality). The results suggest, for the first time, that the ICSI procedures currently used for animal and human ICSI are neither detrimental to embryonic development nor detrimental to embryo quality.

Acute emphysematous cholecystitis associated with pneumobilia: a case report

This report describes a rare case of acute emphysematous cholecystitis with pneumobilia in the common bile duct. The patient was a 66-year-old woman with a part history of diabetes mellitus, and operations for gastric and breast carcinoma. The chief complaint was pain in the right hypochondrium with severe right hypochondrial tenderness and distention of the gallbladder detected on examination. Laboratory tests showed leukocytosis, marked elevation of CRP, jaundice, liver dysfunction, and hyperglycemia. Gas was detected in the gallbladder on plain abdominal X-rays and CT scans of the abdomen, and a small amount of gas was also observed in the common bile duct. On the day of admission, percutaneous transhepatic gallbladder drainage (PTGBD) was carried out under ultrasound guidance, and Clostridium perfingens and E. coli were detected in the bile. Imaging after PTGBD showed no cystic duct obstruction. On the 12th day after PTGBD, cholecystectomy and choledochotomy with primary closure were performed. The postoperative course was good and the patient was discharged on the 15th day after surgery.

Dopamine D2 receptor plays a critical role in cell proliferation and proopiomelanocortin expression in the pituitary

BACKGROUND

It has been suggested that the dopaminergic system is involved in the inhibitory control of secretion of pituitary hormones and in the regulation of motor function in the striatum. To elucidate the specific role of the dopamine D2 receptor (D2R) in the pituitary and brain, we generated D2R deficient (D2R mutant) mice using the gene targeting method.

RESULTS

Electrophysiological studies as well as ligand binding assays show no functional D2R in mutant mice. The D2R mutant mice display a hypoactivity and a slow, creeping movement. The expression of enkephalin mRNA in the striatum is increased in the mutant mice, but not that of dynorphin and substance P. D2R mutant mice have significantly darker coat colour than their wild-type littermates and show an elevation of plasma alpha-melanocyte stimulating hormone (alpha-MSH) levels. We found corresponding hyperplastic changes of intermediate lobe of the pituitary and the increased expression of pro opiomelanocortin (POMC) in the pituitary in D2R mutant mice.

CONCLUSIONS

D2R plays a critical role in the inhibitory regulation of endocrine cell proliferation and the transcription of POMC mRNA, and consequently in the regulation of alpha-MSH in plasma. D2R might be involved in the regulation of enkephalin expression in the striatum, and hence might affect the movement and the behaviour.

Possible effects of placental leucine aminopeptidase on the regulation of brain-gut hormones in the fetoplacental unit

The hydrolysis of somatostatin by human placental subcellular fractions and pregnancy sera was studied in the presence of selective inhibitors and the antibody against pregnancy serum oxytocinase (placental leucine aminopeptidase; EC3.4.11.3) by measuring the released amino acids by high-performance liquid chromatography. We also studied the degradation of other brain-gut hormones, such as glucagon, growth hormone, growth hormone releasing factor, and insulin, in the human placenta and found that the human placenta degrades somatostatin, glucagon, and growth hormone releasing factor, but not insulin and growth hormone. The degradation velocity of somatostatin was ten times greater than that of growth hormone releasing factor in placental microsomal fractions. Our data suggest that the stimulatory control by growth hormone releasing factor is dominant in the fetal growth hormone secretion. Our data also identified the somatostatin-degrading protease in human placenta using placental leucine aminopeptidase. It is known that the mean somatostatin levels in the umbilical artery are about 2.5-fold higher than those in the umbilical vein. Our data on somatostatin levels in umbilical artery and vein of intrauterine growth retardation human fetuses showed that the ratio umbilical artery/vein is around 1. Since insulin is known to be the primary hormone regulating the ratio of fetal growth, our data suggest that the degradation of somatostatin in the placenta is decreased and that elongation of somatostatin effects may result in the inhibition of insulin secretion in the intrauterine growth retardation fetus.

Scavenging effects of tea catechins and their derivatives on 1,1-diphenyl-2-picrylhydrazyl radical

The scavenging effects of tea catechins and their epimerized, acylated, and glucostylated derivatives on 1,1-diphenyl-2-picrythydrazyl (DPPH) radical were evaluated by electron spin resonance spectrometry. Tea catechins and their epimers were shown to have 50% radical scavenging ability in the concentration range of 1 to 3 microM. No significant differences were observed between the scavenging activities of tea catechins and their epimers, and, hence, the scavenging effects of catechins are not dependent on their sterical structure. The relationship between scavenging ability and the structure of tea catechins was also examined with acylated and glucosylated catechin derivatives. It is suggested that the galloyl moiety attached to flavan-3-ol at 3 position has a strong scavenging ability on the DPPH radical as well as the ortho-trihydroxyl group in the B ring, which elevates the radical scavenging efficiency above that of the ortho-dihydroxyl group; as has been recognized in other flavonoids such as flavones. The results obtained from the reactivity of tea catechins with the DPPH radical at different pHs suggest not only that the ortho-trihydroxyl group and the galloyl moiety contribute to maintaining the DPPH radical scavenging ability more effectively in a wide range of conditions from acidic to alkaline, but also that the radical scavenging efficiency of the ortho-dihydroxyls in the B ring is limited in neutral to alkaline regions. The difference between the scavenging abilities of the trihydroxyls (probably in the galloyl moiety) and the dihydroxyls can be explained in terms of redox potentials. It is concluded that the ortho-trihydroxyl group in the B ring and the galloyl moiety at 3 position of flavan-3-ol skeleton are the most important structural features for displaying an excellent scavenging ability on the DPPH radical.

Diet-induced hypercholesterolemia increases endothelin-1 release by aortic endothelial cells

Our previous studies demonstrated the morphological heterogeneity of endothelial cells (ECs) and the emergence of large multinucleated ECs in human and animal atherosclerotic lesions. To investigate the functional alteration of ECs in diet-induced atherosclerosis, immunoreactive endothelin-1 (irET-1) release by ECs of the rabbit aorta was correlated with scanning electron microscopy. Rabbits were fed a cholesterol diet for 12 weeks: by scanning electron microscopy, the area of ECs in the aorta increased in the hypercholesterolemic (HC) group as atherosclerosis progressed. Cultured ECs of the HC group released significantly more irET-1 than ECs of the control. The plasma irET-1 level was also elevated in the HC group. The results obtained suggest that accelerated secretion of ET-1 by ECs contributes to the development of atherosclerotic vascular lesions.

Calcitonin gene-related peptide (CGRP) induces more potent vasorelaxation in the resistance portion than in the conduit portion of mesenteric arteries in humans

Although physiological processes related to vascular function differ greatly between resistance arteries and conduit arteries, it is not known whether the effects of calcitonin gene-related peptide (CGRP), a vasodilator neuropeptide, on these arteries differ in humans. In the present study, the conduit portion and the resistance portion of isolated human mesenteric arteries were suspended in a Krebs-Ringer solution. CGRP produced vasorelaxations in both portions. The EC50 values were very low both in the resistance portion (2.4 x 10(-9) M, n = 7) and in the conduit portion (2.2 x 10(-9) M, n = 7). The maximum response to CGRP in the resistance portion was significantly greater than that in the conduit portion (94.6 +/- 4.0% vs. 64.1 +/- 2.6% relaxation of methoxamine-induced precontraction, both n = 7, p < 0.01). These data suggest that CGRP is one of the most potent endogenous vasodilators in both the resistance portion and the conduit portion of the human mesenteric arteries, and that CGRP induces more potent vasorelaxation in the resistance portion than in the conduit portion of these arteries.

Oxytocin is hydrolyzed by an enzyme in human placenta that is identical to the oxytocinase of pregnancy serum

The hydrolysis of oxytocin (OT) by human placental subcellular fractions and pregnant sera was studied in the presence of bestatin, a potent inhibitor of aminopeptidases, and the antibody against pregnant serum oxyotocinase (P-LAP)(EC 3.4 11.3) by measuring liberated amino acids by high performance liquid chromatography (HPLC). Our immunotitration study and the effect of bastatin on the oxytocin-degrading protease showed that the initiating and responsible protease in oxyotocin degradation in human placenta and pregnant serum is P-LAP.

Carotid-cavernous sinus fistula and aneurysmal rupture associated with fibromuscular dysplasia. A case report

A patient with carotid-cavernous sinus fistula associated with fibromuscular dysplasia, who died from rupture of an associated splenic aneurysm despite successful treatment of the CCF, is reported. When multivessel involvement with aneurysmal dilatation is observed in patients with fibromuscular dysplasia, the possibility of aneurysm ruptures in any of the arteries should be considered.

Cooperative clinical trial of photodynamic therapy with photofrin II and excimer dye laser for early gastric cancer

BACKGROUND AND OBJECTIVE

Photodynamic therapy (PDT) is a recently developed endoscopic method for treating malignant tumors. For obtaining more photodynamic action with less thermal effect, we employed as the excitation light source for PDT an excimer dye laser, which is a pulsed laser with extremely high peak power, instead of an argon dye laser, which is a continuous wave laser and has been used conventionally.

STUDY DESIGN/MATERIALS AND METHODS

The effect of PDT using Photofrin II and the excimer dye laser was evaluated in 27 patients with early gastric cancer.

RESULTS

Complete responses (CR) were obtained in 88% of 24 assessable patients and the response rate was 100%. CR was observed in all cases of lesions of superficial depressed type without ulceration and/or with tumor diameter less than 2 cm. Regarding toxicity, mild cutaneous reaction and photosensitivity were seen and lasted several weeks. There were no serious abnormalities in laboratory tests.

CONCLUSION

We conclude that PDT is a promising modality for early gastric cancer.

[Genetic analysis of facioscapulohumeral muscular dystrophy (FSHD)]

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant muscular disorder which is characterized by progressive weakness and atrophy of the facial, shoulder-girdle and upper arm muscles, and occasional subsequent pelvic-girdle and lower limb involvement. The gene responsible for FSHD has been localized to chromosome 4q35-qter, although a few 4q-unlinked families are known. To examine FSHD-associated DNA rearrangements in the Japanese population, we performed Southern blot analysis of the genomic DNA, using the p13E-11 and pFR-1 probes. Most of the Japanese FSHD patients (> 95%) had specific smaller (< 28 kb) EcoRI fragments which cosegregated with the disease. Restriction enzyme maps of the polymorphic EcoRI fragment detected by the probes have revealed that the disease occurs due to a deletion of the integral numbers of the 3.3kb KpnI tandemly repeated fragments (D4Z4) which contain homeobox-like sequences. Indeed, we cloned and characterized the FSHD-associated EcoRI fragments (the shortest fragment identified to date: 10kb) from two severely affected patients (unrelated). The 10kb fragment were identical and contained only one 3.3kb KpnI repeat unit. Although we still do not know whether truncation deletion of the D4Z4 region could produce FSHD directly or indirectly (position effect), we now beginning to understand FSHD. In the next step, FSHD gene products (mRNA and protein) responsible for the disease should be investigated.

Localization of mRNA for phosphatidylinositol 3-kinase in brain of developing and mature rats

In the adult brain, the gene expression for phosphatidylinositol 3-kinase was weak in almost all neurons with relatively high levels in the olfactory bulb, hippocampus, and cerebellum. On the embryonic days high levels of the gene expression were found throughout the entire neuraxis, then decreased gradually to adult levels during postnatal development. The present finding suggests that phosphatidylinositol 3-kinase may contribute not only to neurogenesis but also to some important physiological roles in differentiating and mature neurons.

What is the difference of bone growth in SHR and SD rats?

1. Both sexes of spontaneously hypertensive rats (SHR) and Sprague-Dawley (SD) rats were used in this study. 2. At 6, 12, 18, 24, 30, 36, 42, 48, 54 and 60 weeks old, tibia length (L), volume (V), dry weight (DW), bone mineral density (BMD) in tibia and serum biochemical parameters (Ca2+, Ca, iP, ALP, TRAP) were measured. 3. At the 18 and 48 weeks old, bone morphometry was performed (mineral apposition rate, trabecular bone volume and trabecular thickness). Serum PTH and osteocalcin level were determined in 18 week old rats. 4. The time course change of DW, L and V were almost the same as the trends of bodyweight in each group, namely, male SD had the highest value, female SD and male SHR showed the same value and the lowest figures were obtained in female SHR. 5. BMD of the middle area showed almost the same trends with the time course change of bodyweight. On the other hand, both sexes of SHR had lower BMD than that of SD in the proximal area. 6. Serum biochemical parameters showed the same trends in both sexes of SD and SHR except for ALP (a marker of bone formation) which was higher in male than in female rats. 7. Mineral apposition rate, trabecular bone volume and trabecular thickness were not different between the same sex of SD and SHR. 8. These findings suggest that trabecular bone in SHR had a lower mineral status than that of SD rats not only in the adult but also in the young. This alteration may due to the abnormal mineralization mechanisms.

Initiating and responsible enzyme of arginine vasopressin degradation in human placenta and pregnancy serum

The hydrolysis of arginine vasopressin (AVP) by human placental subcellular fractions and pregnancy sera was studied in the presence of selective inhibitors and the antibody against pregnancy serum oxytocinase (P-LAP) (EC 3.4.11.3) by measuring liberated amino acids by high-performance liquid chromatography (HPLC). AVP degradation by placental subcellular fractions and pregnancy sera was inhibited by bestatin. The IC50 values of bestatin on AVP degradation by placental subcellular fractions and pregnancy sera were similar to that of this inhibitor on the P-LAP measured by L-Leu-p-nitroamnilide as a substrate (LAP activity), which we reported previously. Our immunotitration study clearly showed that the initiating and responsible protease in AVP degradation in human placenta and pregnancy serum is P-LAP. Since N-benzylcarbonyl-valyl-prolinal (Z-Val-prolinal), a selective inhibitor of post-proline endopeptidase, and phosphoramidon, a putative endopeptidase-24.11 inhibitor, could not significantly influence the degradation of AVP by placental microsomal fractions. Neither enzyme seems to be actively involved in AVP degradation.

[Removal of infected pacemaker leads in the elderly under extracorporeal circulation: two case reports and review of Japanese literature]

Two elder cases in whom infected pacemaker leads were removed under extracorporeal circulation (ECC) are reported. The leads could not be with drawn without direct sharp dissection under ECC because they had become firmly encased with fibrous tissue within the right ventricle. Postoperative courses were uneventful and neither of these patients has experienced recurrent infection to date. Removal with ECC seems to be a safe and effective procedure even in the elderly, provided that cardiac function is good.

Effect of the potassium channel opener YM934 on the contractile response to electrical field stimulation in pig detrusor smooth muscle

PURPOSE

The effect of a potassium channel opener, YM934, on the contractile response to excitatory neurotransmitters was investigated in isolated pig detrusor smooth muscle.

MATERIALS AND METHODS

Electrical field stimulation (EFS; 5 second trains, 50 V, 0.8 msec. duration), alpha, beta-MeATP (3 x 10(-7) to 10(-5) M.) or carbachol (3 x 10(-8) to 10(-6) M.) produced a contractile response in isolated pig detrusor smooth muscle. The effect of YM934 on the contractile responses was evaluated in comparison with the antagonism of the putative cotransmitters, acetylcholine and ATP.

RESULTS

A tetrodotoxin-sensitive, frequency-dependent contractile response to electrical field stimulation was obtained. Atropine (3 x 10(-8) M.) significantly inhibited the contractile response at high frequencies, whereas alpha, beta-MeATP (5 x 10(-6) M.) (desensitizer of P2X-purinoceptors) significantly inhibited the response at low frequencies. YM934 (10(-8) to 10(-7) M.) dose-dependently inhibited the nerve-mediated contractile responses to all frequencies but preferentially at low frequencies, by analogy with alpha, beta-MeATP. A combination of YM934 (3 x 10(-8) M.) and atropine (3 x 10(-8) M.) reduced the response at all frequencies to between 10 and 20% of control, an effect similar to that obtained with alpha, beta-MeATP (5 x 10(-6) M.) and atropine (3 x 10(-8) M.). In addition, YM934 (3 x 10(-8) M.) markedly inhibited the contractile response induced by exogenously applied alpha, beta-MeATP (3 x 10(-7) to 10(-5) M.) but only slightly inhibited the contractile response induced by exogenously applied carbachol (3 x 10(-8) to 10(-6) M.).

CONCLUSION

These results suggest that YM934 may hyperpolarize the membrane of pig detrusor smooth muscle through the opening of ATP-sensitive potassium channels and, as a result, may functionally inhibit the contractile response to purinergic nerve stimulation that elicits the membrane depolarization.

HTLV-I associated uveitis in central Japan

AIMS/BACKGROUND

Recently HTLV-I has been shown to cause a kind of endogenous uveitis in south west Japan, where HTLV-I infection is highly endemic. To investigate further the association of HTLV-I infection with the incidence of this uveitis, HTLV-I seroprevalence in central Japan, where HTLV-I infection is not endemic, was studied.

METHODS

HTLV-I seroprevalence was investigated in 1579 patients with various ocular diseases and 1251 normal volunteers as a younger control group. Then HTLV-I seroprevalence was compared in each group.

RESULTS

Of 1579 patients with various ocular diseases, 38 (2.41%) were seropositive. There was a statistically significant difference in HTLV-I seroprevalence between the undefined uveitis group and non-uveitic ocular diseases group (p < 0.05, Yates's correction). However, the seroprevalence in younger patients with undefined uveitis did not differ significantly from that in other groups. As regards the incidence of this type of uveitis, six of 12 (50%) seropositive patients, who were born in south west Japan and had lived in this area for 35 years, developed this undefined uveitis whereas only two of 26 (7.69%) seropositive patients in the other areas in Japan developed this uveitis. The difference was statistically significant (p < 0.05, Fisher's exact probability test).

CONCLUSION

These results suggest that the incidence of this type of endogenous uveitis could be greatly influenced by environmental or hereditary factors including HLA.