Fiberscope-assisted evaluation of prereconstructed and postreconstructed external auditory canal

The malignant tumors of the external auditory canal often invade the middle ear area through the narrow canal, so it is difficult to determine the surgical excisional margin. A patient undergoing external auditory canal reconstruction following excision of a squamous cell carcinoma using a chondrocutaneous flap and fiberscope-assisted preoperative and postoperative diagnoses are described. We obtained good patency of the canal postoperatively. This technique is quite simple and easy to use. We believe fiberscope-assisted surgery is useful for extracting lesions in small areas. In the future, its application will extend to the area of plastic surgery.

The lateral thigh V-Y flap for the repair of ischial defects

The lateral thigh fasciocutaneous flap described by Maruyama et al in 1984 is a useful method for the repair of ischial and trochanteric defects. We clinically re-evaluated the potential vascular territory of the nutrient artery for this flap, i.e., the first profunda perforator, and have newly designed the postero-lateral thigh V-Y flap in the area including the proximal two-thirds of the posterior thigh. This flap was applied to five difficult or recurrent ischial defects, and satisfactory results were obtained in all cases. For the reconstruction of ischial defects, the postero-lateral thigh V-Y flap has the following advantages; the proximal and well-vascularised portion of the flap is inserted into the area of the previously excised pressure sore, and this flap can potentially be readvanced if a recurrent pressure sore should develop. A Z-plasty can be performed to prevent excessive tension on the skin closure at the junction of the V-Y advancement flap. The postero-lateral thigh V-Y flap can be considered one of the first-line options for both primary and recurrent ischial pressure sores.

A simple method for earlobe reconstruction

We describe a technique for earlobe construction using the V-shaped flap with rotation and transposition techniques. This technique produces a natural appearing lobule without unpleasant secondary deformity. This method has been used on two patients, with very good results.

Primary osteosarcoma of the urinary bladder

Primary osteosarcoma of the bladder, together with transitional cell carcinoma, occurred in a 74-year-old female presenting with haematuria and lumbago. She was treated with chemotherapy and radical cystectomy. Though it was conceived to be curative, she died of a recurrence 5 months after the operation. Primary osteosarcoma of the bladder is an unusual and highly malignant disease. In spite of radical therapy, the outcome has been dismal with some exceptions.

Immunohistochemical studies of proliferating cell nuclear antigen and cathepsin D in transitional cell carcinoma of the urinary bladder

Immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and cathepsin D was performed on 60 transitional cell carcinoma (TCC) specimens from 60 patients with bladder cancer. The percentage of PCNA-positive cells (PCNA-labelling index) was determined by counting 500 or 1,000 cells, and cathepsin D expression was graded according to the extent of immunoreactivity to anti-cathepsin D antibody. The PCNA-labelling index was significantly higher in high-grade and high-stage tumors compared to that in low-grade and low-stage tumors. Cathepsin D was highly positive in grade-1 tumors. In contrast, 82% of grade-3 tumors and 76% of advanced tumors showed negative or low reactivity to anti-cathepsin D. Groups of high PCNA-labelling index and negative cathepsin D had significantly poorer prognoses compared to those of the low PCNA group and cathepsin D highly positive group, respectively, in univariate analyses. However, neither of these two factors were independent prognostic factors in multivariate analyses. These results suggest that the PCNA-labelling index and cathepsin D expression may indicate the malignant potential of TCC and may be able to provide additional information for predicting survival when stratifying for grade of bladder cancer.

Cationic liposomes are a strong adjuvant for a DNA vaccine of human immunodeficiency virus type 1

Liposomes have been widely used to enhance the immune response. In the present investigation, we studied their in vivo immunomodulation of an HIV-1-specific DNA vaccine candidate (pCMV160/REV) constructed with the cytomegalovirus (CMV) promoter-conjugated HIV-1 env and rev DNA plasmids. By immunizing with pCMV160/REV and cationic liposomes through various routes (intramuscular, intraperitoneal, subcutaneous, intradermal, and intranasal), we induced higher levels of both antibody production and delayed-type hypersensitivity (DTH) than by using DNA vaccine alone. The HIV-1-specific cytotoxic T lymphocyte (CTL) activity was observed to be stronger on immunization with the DNA vaccine and cationic liposome combination. The intramuscular, intraperitoneal, and intranasal inoculation routes were more effective in inducing strong DTH and antibody responses than the subcutaneous and intradermal routes. Taken together, these results suggest that cationic liposomes can be highly effective when used with DNA vaccines and administered by various routes.

Intranasal immunization of a DNA vaccine with IL-12- and granulocyte-macrophage colony-stimulating factor (GM-CSF)-expressing plasmids in liposomes induces strong mucosal and cell-mediated immune responses against HIV-1 antigens

A DNA vaccine constructed with the CMV promoter conjugated to env gp160 and rev genes has been shown to induce an effective Th1-type immune response when inoculated via an intramuscular route. In the present study, we obtained high levels of both humoral and cell-mediated immune activity by intranasal administration of this DNA vaccine. The production of mucosal IgA Ab in feces and vaginal fluid was stimulated significantly by intranasal DNA administration. This route of administration resulted in a significant level of HIV-1-neutralizing Abs in feces and serum. Cytokine assays revealed that intranasal administration of this DNA vaccine induces a Th2-type immune response. Interestingly, cationic liposomes greatly enhanced these activities. Abs against HIV-1 were present for at least 10 mo. Coadministration of the DNA vaccine with IL-12- and granulocyte/macrophage-CSF-expressing plasmids induced high levels of HIV-specific CTLs and an increase in delayed type hypersensitivity when administered by the intranasal route. These results clearly demonstrate that intranasal administration of this DNA vaccine with liposomes, together with IL-12- and/or granulocyte/macrophage-CSF-expressing plasmids, induces a strong level of anti-HIV-1 immune response.

Intranasal immunization of a DNA vaccine with IL-12- and granulocyte-macrophage colony-stimulating factor (GM-CSF)-expressing plasmids in liposomes induces strong mucosal and cell-mediated immune responses against HIV-1 antigens

A DNA vaccine constructed with the CMV promoter conjugated to env gp160 and rev genes has been shown to induce an effective Th1-type immune response when inoculated via an intramuscular route. In the present study, we obtained high levels of both humoral and cell-mediated immune activity by intranasal administration of this DNA vaccine. The production of mucosal IgA Ab in feces and vaginal fluid was stimulated significantly by intranasal DNA administration. This route of administration resulted in a significant level of HIV-1-neutralizing Abs in feces and serum. Cytokine assays revealed that intranasal administration of this DNA vaccine induces a Th2-type immune response. Interestingly, cationic liposomes greatly enhanced these activities. Abs against HIV-1 were present for at least 10 mo. Coadministration of the DNA vaccine with IL-12- and granulocyte/macrophage-CSF-expressing plasmids induced high levels of HIV-specific CTLs and an increase in delayed type hypersensitivity when administered by the intranasal route. These results clearly demonstrate that intranasal administration of this DNA vaccine with liposomes, together with IL-12- and/or granulocyte/macrophage-CSF-expressing plasmids, induces a strong level of anti-HIV-1 immune response.

Effect of oxidized low density lipoprotein on thrombomodulin expression by THP-1 cells

We have investigated the effects of oxidized low density lipoproteins (oxidized LDL) on the expression of TM by THP-1 monocytic cells. TM antigen levels and its cofactor activity for thrombin-dependent protein C activation were increased by oxidized LDL and accompanied by an increase in TM mRNA levels. Incubation of THP-1 cells with 300 microg/ml oxidized LDL for 24 h resulted in an 80% increase of cellular TM antigen levels. Native LDL and acetylated LDL did not affect the TM expression by these cells. The resultant aqueous phase after extraction of oxidized LDL by chloroform/methanol increased the TM antigen levels as well as oxidized LDL. Phorbol 12-myristate 13-acetate (PMA) also increased the TM antigen level 2.1 times the control and was accompanied by the adhesion of cells to plastic dishes and increasing macrophage cell surface antigen CD14 levels. In contrast, oxidized LDL did not induce differentiation to the macrophage. The present results indicate that oxidized LDL increases cellular TM antigen without cellular differentiation and that up-regulation of TM by oxidized LDL in monocytes may have some implication in atherosclerosis.

The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction

The V-Y advancement myotarsocutaneous flap was used to avoid excessive scarring during reconstruction of a full-thickness upper eyelid defect following surgical excision of a malignant tumor. This method has a number of advantages: It has a short operative time, it is a one-stage procedure, it does not require lining by auricular or septal cartilage, the technique is relatively simple, and the scar is inconspicuous, since both flap margins are placed in skin creases. The V-Y myotarsocutaneous flap is best suited for the repair of full-thickness upper eyelid defects ranging from 25 to 50 percent of the lid width when the remaining lateral canthal structures are adequate to support the flap.

HIV-1-specific cell-mediated immune responses induced by DNA vaccination were enhanced by mannan-coated liposomes and inhibited by anti-interferon-gamma antibody

The adjuvant effect of mannan-coated liposomes on human immunodeficiency virus type-1 (HIV-1) DNA vaccine and the mechanism of this enhancement were studied. Coating of cationic liposomes with mannan significantly enhanced the ability of this vaccine to induce an HIV-specific delayed-type hypersensitivity (DTH) response. HIV-specific cytotoxic T-cell (CTL) activity elicited by DNA vaccination was also significantly enhanced with the mannan-liposome cocktail. This mannan-liposome-mediated activity was greatly inhibited by in vivo injection of anti-interferon (IFN)-gamma antibody, which suggests that IFN-gamma plays an important role in this HIV-specific immune response. The results of both isotype-specific antibody and cytokine analysis revealed that mannan-liposome-mediated DNA vaccination enhances Th1-mediated immunity.

Bilobed fasciocutaneous flap for primary repair of a large upper arm defect with secondary closure of the donor site without a skin graft

Primary repair of 2 patients with large upper arm defects with the bilobed fasciocutaneous flap is reported. In this procedure the repair of a large soft-tissue defect with a flap prepared adjacent to the defect and closure of the flap donor site are performed at the same time without a skin graft. This procedure enabled regional reconstruction and provided excellent aesthetic results. It is simple and reliable. In addition, primary repair of large upper arm defects can be expected.

Investigation of the effect of discrete absorbers upon the measurement of blood volume with near-infrared spectroscopy

This paper derives an analytical model for investigating the effect of the distribution of absorbers upon light attenuation in a scattering medium. Results from this are found to agree with those of Monte Carlo simulations. The implications of this model are then examined for their likely effect upon the measurement of cerebral blood volume (CBV) using near-infrared (NIR) spectroscopy. We conclude that, given the small diameter of the majority of cerebral blood vessels, the distribution of the blood will have little effect upon the measurement of CBV. Where changes to the blood volume occur in the larger (> 0.2 mm diameter) vessels on the surface of the brain, NIR spectroscopy is likely to underestimate the change.

Drinking habit as a base for blood pressure elevation--difference in epidemiological significance by beverage type

To investigate whether blood pressure differs by taking preferred alcoholic beverage among habitual drinkers, systolic and diastolic blood pressure (SBP, DBP) were compared among groups with different beverage types in 563 middle-aged Japanese males using data from a cross-sectional health survey conducted from February, 1989 through March, 1991 in five areas of Japan. Mean values of SBP and DBP, adjusted for residence, age and body mass index (BMI), were significantly greater in 'exclusively sake' drinkers (adjusted SBP: 127.2 mmHg, adjusted DBP: 83.0 mmHg) and in 'exclusively shochu' drinkers (adjusted SBP: 127.5 mmHg, adjusted DBP: 84.2 mmHg) than in non-drinkers (adjusted SBP: 120.9 mmHg, adjusted DBP: 77.3 mmHg). Adjusted SBP and DBP of 'exclusively beer' drinkers (adjusted SBP: 121.9 mmHg, adjusted DBP: 79.1 mmHg) were significantly (for SBP: p = 0.016, for DBP: p = 0.008) lower than those of 'exclusively sake' drinkers. Similar patterns of blood pressure differences between five beverage types of habitual drinkers were found especially in the group with less than 150 g of weekly ethyl-alcohol consumption. Even after adding ethyl-alcohol consumption as a covariate among 479 habitual drinkers, the significant differences in adjusted SBP and DBP between 'exclusively beer' drinkers and 'exclusively sake' drinkers (for SBP: p = 0.032, for DBP: p = 0.044) were noted. These results may suggest that the effects of drinking on blood pressure differ by beverage type in middle-aged Japanese males.

Theoretical and experimental investigation of near-infrared light propagation in a model of the adult head

Near-infrared light propagation in various models of the adult head is analyzed by both time-of-flight measurements and mathematical prediction. The models consist of three- or four-layered slabs, the latter incorporating a clear cerebrospinal fluid (CSF) layer. The most sophisticated model also incorporates slots that imitate sulci on the brain surface. For each model, the experimentally measured mean optical path length as a function of source-detector spacing agrees well with predictions from either a Monte Carlo model or a finite-element method based on diffusion theory or a hybrid radiosity-diffusion theory. Light propagation in the adult head is shown to be highly affected by the presence of the clear CSF layer, and both the optical path length and the spatial sensitivity profile of the models with a CSF layer are quite different from those without the CSF layer. However, the geometry of the sulci and the boundary between the gray and the white matter have little effect on the detected light distribution.

Treatment of vaginal agenesis with an expanded vulval flap

We propose a vaginal reconstruction method using an expanded vulval flap. This technique avoids long-term dilation and combines the advantages of commonly used methods of treatment for vaginal agenesis, resulting in good functional outcome.

Experimental validation of Monte Carlo and finite-element methods for the estimation of the optical path length in inhomogeneous tissue

To validate models of light propagation in biological tissue, experiments to measure the mean time of flight have been carried out on several solid cylindrical layered phantoms. The optical properties of the inner cylinders of the phantoms were close to those of adult brain white matter, whereas a range of scattering or absorption coefficients was chosen for the outer layer. Experimental results for the mean optical path length have been compared with the predictions of both an exact Monte Carlo (MC) model and a diffusion equation, with two differing boundary conditions implemented in a finite-element method (PEM). The MC and experimental results are in good agreement despite poor statistics for large fiber spacings, whereas good agreement with the FEM prediction requires a careful choice of proper boundary conditions.

Endoscopic extraction of lipomas using an ultrasonic suction scalpel

Lipomas were extracted with an ultrasonic suction scalpel, assisted by an endoscope, with good results. The combined surgical technique is described in this paper. Preoperative clinical findings and diagnostic imaging of the patients provided a preoperative diagnosis of lipomas. For the procedure, the endoscope was inserted through a small incision immediately above the tumor. The tumor was endoscopically confirmed and then extracted with an ultrasonic scalpel. Complete lipoma extraction was achieved in all patients without recurrence. The patients had good cosmetic results with only minimal postoperative scarring. The endoscopic extraction of lipomas with an ultrasonic scalpel is proven to be highly useful, especially for large tumors, and permits a less invasive and more reliable surgical operation.

The effect of overlying tissue on the spatial sensitivity profile of near-infrared spectroscopy

The exact volume of brain tissue interrogated in near-infrared spectroscopy (NIRS) studies of cerebral oxygenation in unknown, the inhomogeneity of the head and resulting variation in optical paths making determination of the interrogated volume difficult. In this study, the spatial sensitivity profiles in simple two-component inhomogeneous cylindrical models are predicted by Monte Carlo simulation in order to reveal the effects of the overlying tissue on the volume of tissue interrogated by NIRS. The predictions are validated by experimental measurements on solid "tissue equivalent' cylindrical phantoms. The phantom diameter is 30 mm and the thickness of the outer layer is 2 mm. The optical properties of the inner cylinder match those of adult brain white matter (mu' s1 = 6.4 mm-1 and mu' a1 = 0.02 mm-1), but those of the outer layer are changed (mu' s0 from 1.7 to 8.3 mm-1 and mu' a0 from 0.002 to 0.1 mm-1). Results show that the spatial sensitivity profile is largely confined to the outer layer at small optode spacing (< 15 degrees) and to the inner layer at large spacing (> 120 degrees). At intermediate angles, the sensitivity profiles are sensitive to the optical properties of the outer layer. A low mu' s0 or mu' a0 moves the profile toward the surface, at high mu' a0 it moves in towards the inner layer and at high mu' a0 it is similar to the homogeneous case.

Buttock deformity repair for congenital generalized lipodystrophy

A 3-year-old girl suffering from congenital generalized lipodystrophy is presented. Almost all features of CGL described by Seip were found in our patient. The deformity of the patient's buttocks was repaired using bilateral gluteus maximus muscle flap advancement, with good result.

The biphasic changes in splenic natural killer cell activity following ventromedial hypothalamic lesions in rats

The cytotoxic activity of natural killer (NK) cells in the spleen was measured by a standard 4-h chromium release assay following electrical lesioning of the ventromedial hypothalamic nucleus (VMH) in rats. The splenic NK cell activity of VMH lesioned rats was found to be significantly suppressed at effector:target cell ratios of 100:1 and 50:1 compared with that of sham lesioned rats on day 4 after the lesion. On the other hand, on day 49, the VMH lesioned animals that had become hyperphagic and obese showed an enhancement of splenic NK cell activity compared with sham lesioned animals. The mechanisms of the biphasic change in NK cell activity following the VMH lesions are discussed.

Selective intrathecal phenol block to improve activities of daily living in patients with spastic quadriplegia. A preliminary report

To eliminate severe leg spasms of 15 quadriplegics, 0.3 ml 10% phenol-glycerin was injected into the subarachnoid space at the T12/L1 interspace. The effectiveness for leg spasm was evaluated by the Penn spasticity and Ashworth rigidity scales. Three patients remained completely flaccid; however three had slight, six had moderate and three had complete recurrence of spasms in a follow up period of observation for 1 to 22 (average 13) months. The result of selective intrathecal phenol block was significantly valuable, improving the activities of daily living (ADL) of quadriplegic patients. There were no systemic side effects nor disturbance of bladder, bowel or sexual functions.

Mucoid degeneration of the atrioventricular valve caused by cardiac lymphostasis: An experimental study in dogs

We performed an experiment to examine the influence of cardiac lymph congestion on the cardiac valves in dogs. A total of 6 mongrel dogs underwent surgery to induce cardiac lymph congestion, and 6 other animals underwent sham operation. Two weeks after operation, the atrioventricular valves of the experimental animals were intensively stained by Alcian blue. The optical densities of the tricuspid valves measured by a microscopic photometer were 0.069 ± 0.033 in the proximal portion, 0.134 ± 0.030 in the middle portion, and 0.117 ± 0.023 in the peripheral portion. All corresponding values obtained from the sham-operated animals showed lower values of 0.048 ± 0.012, 0.046 ± 0.014 (p < 0.05), and 0.060 ± 0.028 (p < 0.01), respectively. Electron microscopic observation revealed dilatation of the lymphatic vessels in the experimental valves. The results suggest that cardiac lymph congestion causes accumulation of mucopolysaccharides in the valve.

[Factors related to postoperative hydronephrosis following ureteroneocystostomy in neurogenic bladders]

A total of 68 ureteroneocystostomies performed between 1980 and 1992 in 63 patients with vesicoureteral reflux (UVR) secondary to neurogenic bladder were reviewed to elucidate factors of postoperative hydronephrosis. Urogram, cystogram, and urodynamics were analyzed, and the cases were classified into two types (areflexia, hyperreflexia) of detrusor muscle response. Occurrence or progression of hydronephrosis was demonstrated in 26 operations (complicated group). Compared with the rest (uncomplicated group), significant difference was not observed concerning proportions of vesical deformity, VUR grades, preoperative hydronephrosis, cystometric types and operative factors. In cases of hyperreflexia maximum vesical volume, maximum vesical pressure or maximum urethral pressure was not different between both groups. However, in those of areflexia maximum vesical volume of the complicated group was significantly smaller than that of the uncomplicated group (290 +/- 35 ml vs. 370 +/- 35 ml, P = 0.03), and the proportion of bladders with compliance less than 10 ml/cmH2O was significantly higher in the complicated group than in the uncomplicated group (P = 0.05) though maximum vesical pressure or maximum urethral pressure was not different. In areflex bladder deformity was observed more in the complicated group than in the uncomplicated group (P = 0.06). Relative inactiveness of detrusor muscle in areflex bladder might render such preoperative findings as vesical deformity, contracted bladder and low compliance more prognosticative of postoperative hydronephrosis than in hyperreflex bladder. During the follow up (6 to 132, mean 42 months) no case showed progression of hydronephrosis or renal deterioration, nor did any case require revisional surgery.(ABSTRACT TRUNCATED AT 250 WORDS)