The non-vascularised fibular graft: a simple and successful method of reconstruction of the pelvic ring after internal hemipelvectomy

Internal hemipelvectomy is a standard treatment for malignant tumours of the pelvis. Reconstruction using a non-vascularised fibular graft is relatively straightforward compared to other techniques. We describe the surgical and functional outcomes for a series of ten patients who underwent an internal hemipelvectomy (type I or I/IV) with reconstruction by a non-vascularised fibular graft between 1996 and 2009. A key prerequisite for this procedure was a preserved sciatic notch, confirmed pre-operatively on MRI. Graft-host union was achieved in all patients with a single fibular graft, and in the lower graft where two grafts had been used. The mean time to union was 7.3 months (3 to 12). The upper graft did not unite in four of six cases where two grafts had been used. Seven patients were eventually able to walk without a stick. The mean post-operative Musculoskeletal Tumour Society score was 75.4% (16.7 to 96.7). There were no cases of deep post-operative infection. The mean pelvic shortening was 0.9 cm (0.2 to 3.4). Recurrent tumour occurred in three cases, and death from tumour-related disease occured in one. Patients who need an internal hemipelvectomy will do well if their pelvic ring is reconstructed with a non-vascularised fibular graft. The complication rate is low, and they attain a good functional outcome.

The pathophysiological role of PEDF in bone diseases

First discovered in 1991 as a factor secreted by retinal pigment epithelial cells, the potency of pigment epithelium derived factor (PEDF) as an anti-angiogenic has led to examination of its role in active bone growth, repair and remodelling. In the musculoskeletal system, PEDF expression occurs particularly at sites of active bone formation. Expression has been noted in osteoblasts and to a lesser degree osteoclasts, the major classes of bone cells. In fact, PEDF is capable of inducing differentiation of precursor cells into mature osteoblasts. Expression and localisation are closely linked with that of vascular endothelial growth factor (VEGF). Studies at the epiphyseal plate have revealed that PEDF expression plays a key role in endochondral ossification, and beyond this may account for the epiphyseal plate's innate ability to resist neoplastic cell invasion. Collagen-1, the major protein in bone, is avidly bound by PEDF, implicating an important role played by this protein on PEDF function, possibly through MMP-2 and -9 activity. Surprisingly, the role of PEDF has not been evaluated more widely in bone disorders, so the challenge ahead lies in a more diverse evaluation of PEDF in various osteologic pathologies including osteoarthritis and fracture healing.

The significance of size change of soft tissue sarcoma during preoperative radiotherapy

AIM

To assess the significance of change in tumour size during preoperative radiotherapy in patients with soft tissue sarcoma (STS).

METHODS

A retrospective review of 91 cases with STS was performed. Inclusion criteria were localised extremity and truncal STS with measurable disease, older than 18 years, treated with preoperative radiotherapy and wide local excision, in the period between January 1966 and December 2005. Patients with head and neck STS, or who received neoadjuvant chemotherapy were excluded. A difference in excess of 10% of the greatest tumour diameter of the pre-radiotherapy and the post-radiotherapy MRI scans was considered as change in tumour size.

RESULTS

Increase in tumour size was noted in 28 patients (31%) (Group 1). No change or decrease in size was observed in 63 patients (Group 2). There were no significance differences in local control or overall survival rates between the 2 groups. The estimated overall actuarial local recurrence free, event-free and overall survival rates were 90.5%, 64.4%, 62.9% in Group 1, and 85.7%, 60.8%, 68.9% in Group 2 respectively.

CONCLUSION

Increase in tumour size during preoperative radiotherapy for soft tissue sarcoma does not seem to associate with inferior local tumour control or compromise survival. Lack of reduction in tumour size is not necessarily a sign of lack of response to preoperative radiotherapy.

Portal vein thrombosis treated using danaparoid sodium and antithrombin III

A 45-year-old man under treatment for liver cirrhosis (LC) due to chronic hepatitis C and hemophilia A was seen in our emergency room because of a 10-kg weight gain in the previous week due to ascites. Portal vein thrombosis (PVT) was detected with computer tomography (CT) and ultrasonographic (US). Danaparoid sodium (DS) and antithrombin III (AT III) were administrated and doppler US images showed improvement of portal venous blood flow. DS or AT III may be safe and alternative therapies for PVT.

[In vitro susceptibilities to levofloxacin and various antibacterial agents of 12,919 clinical isolates obtained from 72 centers in 2007]

We have reported in this journal in vitro susceptibilities of clinical isolates to antibiotics every year since 1992. In this paper, we report the results of an analysis of in vitro susceptibilities of 12,919 clinical isolates from 72 centers in Japan to selected antibiotics in 2007 compared with the results from previous years. The common respiratory pathogens, Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae maintained a high susceptibility to fluoroquinolones (FQs). The resistance of S. pyogenes to macrolides has been increasing every year and this was especially clear this year. Most strains of Enterobacteriaceae except for Escherichia coli showed a high susceptibility to FQs. Almost 30% of E. coli strains were resistant to FQs and the resistance increased further this year. FQs resistance of methicillin-resistant Staphylococcus aureus (MRSA) was approximately 95% with the exception of 45% for sitafloxacin (STFX). FQs resistance of methicillin-susceptible S. aureus (MSSA) was low at about 10%. FQs resistance of methicillin-resistant coagulase negative Staphylococci (MRCNS) was higher than that of methicillin-susceptible coagulase negative Staphylococci (MSCNS), but it was lower than that of MRSA. However, FQs resistance of MSCNS was higher than that of MSSA. FQs resistance of Enterococcus faecalis was 22.5% to 29.6%, while that of Enterococcusfaecium was more than 85% except for STFX (58.3%). In clinical isolates of Pseudomonas aeruginosa derived from urinary tract infections, FQs resistance was 21-27%, which was higher than that of P. aeruginosa from respiratory tract infections at 13-21%, which was the same trend as in past years. Multidrug resistant strains accounted for 5.6% in the urinary tract and 1.8% in the respiratory tract. Acinetobacter spp. showed high susceptibility to FQs. The carbapenem resistant strains, which present a problem at present, accounted for 2.7%. Neisseria gonorrhoeae showed high resistance of 86-88% to FQs. The results of the present survey indicated that although methicillin-resistant Staphylococci, Enterococci, E. coli, P. aeruginosa, and N. gonorrhoeae showed resistance tendencies, and other species maintained high susceptibility rates more than 90% against FQs, which have been used clinically for over 15 years.

Risk factors for the progression of endoscopic Barrett's epithelium in Japan: a multivariate analysis based on the Prague C & M Criteria

PURPOSE

To determine the prevalence and progression of Barrett's epithelium and associated risk factors in Japan.

METHODS

The study population comprised 869 cases. Endoscopic Barrett's epithelium was diagnosed based on the Prague C & M Criteria. The correlations of clinical factors with the prevalence and progression of endoscopic Barrett's epithelium were examined.

RESULTS

Endoscopic Barrett's epithelium was diagnosed in 374 cases (43%), in the majority of which the diagnosis was short-segment Barrett's esophagus. The progression of Barrett's epithelium was identified in 47 cases. In univariate and multiple logistic regression analyses, aging, smoking habit, and erosive esophagitis were significantly associated with the prevalence of Barrett's epithelium, whereas aging and erosive esophagitis, especially severe erosive esophagitis, were significant contributing factors to the progression of Barrett's epithelium.

CONCLUSIONS

Forty-three percent of the total study population was diagnosed as having endoscopic Barrett's epithelium. During the follow-up period, 12.6% of the cases with Barrett's epithelium exhibited progression which was associated with aging and severe erosive esophagitis.

Aperitif effects on gastric emptying: a crossover study using continuous real-time 13C breath test (BreathID System)

The aim of this study was to determine whether there is a correlation between aperitif and gastric emptying. Ten healthy male volunteers participated in this randomized, two-way crossover study. Under two conditions (after drinking an aperitif versus not), the (13)C breath test was performed for 4 h with a liquid meal (200 kcal/200 ml) containing 100 mg (13)C acetate. We used 50 ml of umeshu as the aperitif. This is a traditional Japanese plum liqueur, and contains 7 ml alcohol (14%). In the aperitif group, T(1/2), T(lag), and T(peak) were significantly delayed [T(1/2) (132: 113-174) versus (112: 92-134) (P = 0.0069); T(lag) (80: 63-94) versus (55: 47-85) (P = 0.0069); and T(peak) (81: 62-96) versus (54: 34-84) (P = 0.0069), (median: range, aperitif versus control, min)]. Gastric emptying was significantly delayed in the aperitif group as compared with the control group. This study revealed that even a small amount of alcohol such as an aperitif may contribute to delayed gastric emptying.

Implantable cardioverter defibrillator discharge rates in patients with unexplained syncope, structural heart disease, and inducible ventricular tachycardia at electrophysiologic study

BACKGROUND AND HYPOTHESIS

The implantable cardioverter defibrillator (ICD) is the best available strategy to protect patients from life-threatening ventricular arrhythmia. Although unproven, it is commonly utilized to treat subjects with syncope, a negative clinical workup, structural heart disease, and inducible sustained monomorphic ventricular tachycardia (VT) on programmed electrophysiologic stimulation (EPS). The purpose of this paper was to validate this approach.

METHODS

We retrospectively identified 36 subjects who received primary ICD therapy for syncope in the setting of structural heart disease with inducible sustained monomorphic VT on EPS. The cohort was predominantly male (32/36) with underlying coronary artery disease (29/36). The mean left ventricular ejection fraction was 31 +/- 12%, and a third of the patients (12/36) had undergone bypass surgery.

RESULTS

The study group was followed for a mean of 23 +/- 15 months (range 3-81 months) and experienced an ICD event rate of 22% at 3 months, which increased to 55% at 36 months. This event rate was comparable with the 66% event rate seen in a group of patients with primary ICD therapy for spontaneous life-threatening VT treated during the same time period. No future predictors of ICD events in the study group could be identified.

CONCLUSION

Syncope patients with negative workup, structural heart disease, and sustained monomorphic VT at EPS are at high risk for future tachyarrhythmic events. Based on present evidence, primary ICD therapy in this group appears warranted and justified.

Short wavelength far infrared laser polarimeter with silicon photoelastic modulators

A short wavelength far infrared laser whose wavelength lambda is about 50 microm is preferable for a polarimeter and an interferometer for high density operations in the Large Helical Device (LHD) and on future large fusion devices such as ITER. This is because the beam bending effect (proportional to lambda(2)) in a plasma, which causes fringe jump errors, is small and the Faraday and the Cotton-Mouton effects are moderate. We have developed a polarimeter with highly resistive silicon photoelastic modulators (PEMs) for the CH(3)OD laser (lambda=57.2 and 47.7 microm). We performed bench tests of the polarimeter with a dual PEM and demonstrated the feasibility for the polarimeter. Good linearity between actual and evaluated polarization angles is achieved with an angular resolution of 0.05 degrees and a temporal resolution of 1 ms. The baseline drift of the polarization angle is about 0.1 degrees for 1000 s.

Detection of high k turbulence using two dimensional phase contrast imaging on LHD

High k turbulence, up to 30 cm(-1), can be measured using the two dimensional CO2 laser phase contrast imaging system on LHD. Recent hardware improvements and experimental results are presented. Precise control over the lens positions in the detection system is necessary because of the short depth of focus for high k modes. Remote controllable motors to move optical elements were installed, which, combined with measurements of the response to ultrasound injection, allowed experimental verification and shot-to-shot adjustment of the object plane. Strong high k signals are observed within the first 100-200 ms after the initial electron cyclotron heating (ECH) breakdown, in agreement with gyrotron scattering. During later times in the discharge, the entire k spectrum shifts to lower values (although the total amplitude does not change significantly), and the weaker high k signals are obscured by leakage of low k components at low frequency, and detector noise, at high frequency.

Two-dimensional phase contrast imaging for local turbulence measurements in large helical device (invited)

Two-dimensional phase contrast imaging (2D) installed on the large helical device (LHD) is a unique diagnostic for local turbulence measurements. A 10.6 microm infrared CO(2) laser and 6x8 channel HgCdTe 2D detector are used. The length of the scattering volume is larger than plasma size. However, the asymmetry of turbulence structure with respect to the magnetic field and magnetic shear make local turbulence measurements possible. From a 2D image of the integrated fluctuations, the spatial cross-correlation function was estimated using time domain correlation analysis, then, the integrated 2D k-spectrum is obtained using maximum entropy method. The 2D k-spectrum is converted from Cartesian coordinates to cylindrical coordinates. Finally, the angle in cylindrical coordinate is converted to flux surface labels. The fluctuation profile over almost the entire plasma diameter can be obtained at a single moment. The measurable k-region can be varied by adjusting the detection optics. Presently, k=0.1-1.0 mm(-1) can be measured which is expected region of ion temperature gradient modes and trapped electron mode in LHD. The spatial resolution is 10%-50% of the minor radius.

Development of a phase contrast imaging system based on a yttrium aluminum garnet laser with folded beam for observations of density fluctuations in compact helical system

A near-infrared laser phase contrast optical system incorporating a folded beam was developed in order to measure the distribution of density fluctuations in a high-temperature plasma. The coherent light source used was an yttrium aluminum garnet laser stabilized by a ring oscillator. The probe beam system separates and reflects the incident and exiting beams with a polarizer and a fully reflective mirror with a waveplate. This system was employed with a compact helical system to detect fluctuations at the plasma edge.

Development of terahertz laser diagnostics for electron density measurements

A two color laser interferometer using terahertz laser sources is under development for high performance operation on the large helical device and for future burning plasma experiments such as ITER. Through investigation of terahertz laser sources, we have achieved high power simultaneous oscillations at 57.2 and 47.6 microm of a CH(3)OD laser pumped by a cw 9R(8) CO(2) laser line. The laser wavelength around 50 microm is the optimum value for future fusion devices from the consideration of the beam refraction effect and signal-to-noise ratio for an expected phase shift due to plasma. In this article, recent progress of the terahertz laser diagnostics, especially in mechanical vibration compensation by using a two color laser operation and terahertz laser beam transmission through a dielectric waveguide, will be presented.

Chronic expanding hematoma in combination with a pseudoaneurysm: a case report

After bleeding from trauma or surgery, most of the hematomas undergo spontaneous reabsorption. But, in some rare cases, hematomas persist for long periods as slowly expanding masses for months or years. These hematomas were termed as chronic expanding hematomas. In this report, we describe a case of chronic expanding hematoma with a pseudoaneurysm that underwent surgical biopsy, which led to an increase in its expansion speed.

Truncation mutations abolish chromatin-associated activities of adenomatous polyposis coli

The adenomatous polyposis coli (APC) is a tumor suppressor whose loss of function leads to colon cancer. APC shuttles between the nucleus and cytoplasm, however its role in the nucleus remains elusive. We have found that nuclear APC specifically associates with transcriptionally active chromatin through structural elements located downstream to the region of frequent truncation mutations found in colorectal tumors. We show that a recombinant APC fragment comprising such elements associates in vivo with euchromatin and preferentially binds in vitro to acetylated histone H3. Induction of DNA double-strand breaks (DSB) stimulates accumulation of APC at the damaged DNA chromatin marked by histone H2AX and S139-phosphorylated histone H2AX. A nuclear complex containing the DNA-dependent protein kinase catalytic subunit (DNAPKcs) and APC associates with chromatin in response to DNA DSB. APC knockdown with siRNA decreased the rate of DNA DSB-induced S139 histone H2AX phosphorylation in cells expressing endogenous full-length APC, but not in colon cancer cells with its truncation mutants, whereas ectopic APC expression stimulated the H2AX phosphorylation regardless of the type of endogenous APC. Our data suggest that APC involves in the DSB DNA repair and that truncation mutations impair chromatin-associated functions of APC.

Isoflurane attenuates myoglobin release during ischemic and/or reperfusion periods

BACKGROUND

Recently, we have developed cardiac microdialysis for detection of protein leakage from the injured myocardium. We examined whether the exposures to isoflurane would exert a beneficial effect on myocardial injury caused by ischemia or reperfusion.

METHODS

A dialysis probe was implanted into the left ventricle free wall in the rabbits. The dialysate myoglobin level served as an index of myocardial interstitial myoglobin levels. Rabbits were randomly assigned to one of three groups: (1) without exposure to isoflurane (vehicle, n=6), (2) inhale 1 MAC isoflurane once for 30 min (ISO30-1, n=6), and (3) twice for 30 min (ISO30-2, n=6). All rabbits underwent 30 min of coronary occlusion and 60 min of reperfusion. To determine whether the isoflurane induced myocardial protection against chemical hypoxia, sodium cyanide (30 mM) was administered and dialysate myoglobin levels were measured with (n=6) and without pre-exposure to isoflurane twice for 30 min (n=6).

RESULTS

In all three groups dialysate myoglobin levels were increased by coronary occlusion and furthermore augmented by reperfusion. In comparison with the vehicle group, the ISO30-1 group suppressed only the increase in the dialysate myoglobin level during reperfusion. The ISO30-2 group suppressed during both the ischemic and reperfusion periods. Cyanide induced increases in dialysate myoglobin levels. These increments in dialysate myoglobin levels were suppressed by repeated exposure to isoflurane.

CONCLUSION

Repeated exposure to isoflurane suppressed myocardial myoglobin release caused by both ischemia and reperfusion injury. Isoflurane may provide protection against myocardial ischemia/reperfusion and hypoxic injuries.

Emission- and fluorescence-spectroscopic investigation of a glow discharge plasma: absolute number density of radiative and nonradiative atoms in the negative glow

The excited-state atom densities in the negative glow of a direct-current glow discharge are derived from the spectral-line intensity of radiative atoms and the resonance-fluorescence photon flux of nonradiative atoms. The discharge is operated in a helium-argon gas mixture (molar fraction ratio 91:9; total gas pressure 5 Torr) at a dc current of 0.7-1.2 mA. The observations are made in the region of the maximum luminance in the cathode region, where high-energy electrons accelerated in the cathode fall are injected into the negative glow. The emission intensities of the He I, He II, Ar I, and Ar II spectral lines are measured with a calibrated tungsten ribbon lamp as an absolute spectral-radiance standard. Fluorescence photons scattered by helium and argon atoms in the metastable state and argon atoms in the resonance state are detected by the laser-induced fluorescence (LIF) method with the Rayleigh scattering of nitrogen molecules as an absolute standard of scattering cross section. The laser absorption method is incorporated to confirm the result of the LIF measurement. Excitation energies of the measured spectral lines range from 11.6 (Ar I) to 75.6 eV (He II), where the excitation energy is measured from the ground state of the neutral atom on the assumption that, in the plasma of this study, both the neutral and the ionic lines are excited by electron impact in a single-step process from the ground state of the corresponding neutral atoms. Experimental evidence is shown for the validity of this assumption.

Characterization of ouabain-induced noradrenaline and acetylcholine release from in situ cardiac autonomic nerve endings

AIM

Although ouabain modulates autonomic nerve ending function, it is uncertain whether ouabain-induced releasing mechanism differs between in vivo sympathetic and parasympathetic nerve endings. Using cardiac dialysis, we examined how ouabain induces neurotransmitter release from autonomic nerve ending.

METHODS

Dialysis probe was implanted in left ventricle, and dialysate noradrenaline (NA) or acetylcholine (ACh) levels in the anaesthetized cats were measured as indices of neurotransmitter release from post-ganglionic autonomic nerve endings.

RESULTS

Locally applied ouabain (100 microm) increased in dialysate NA or ACh levels. The ouabain-induced increases in NA levels remained unaffected by cardiac sympathetic denervation and tetrodotoxin (Na+ channel blocker, TTX), but the ouabain-induced increases in ACh levels were attenuated by TTX. The ouabain-induced increases in NA levels were suppressed by pretreatment with desipramine (NA transport blocker) and augmented by reserpine (vesicle NA transport blocker). In contrast, the ouabain-induced increases in ACh levels remained unaffected by pretreatment with hemicholinium-3 (choline transport blocker) but suppressed by vesamicol (vesicle ACh transport blocker). The ouabain-induced increases in NA levels were suppressed by pretreatment with omega-conotoxin GVIA (N-type Ca2+ channel blocker), verapamil (L-type Ca2+ channel blocker) and TMB-8 (intracellular Ca2+ antagonist). The ouabain-induced increases in ACh levels were suppressed by pretreatment with omega-conotoxin MVIIC (P/Q-type Ca2+ channel blocker), and TMB-8.

CONCLUSIONS

Ouabain-induced NA release is attributable to the mechanisms of regional exocytosis and/or carrier-mediated outward transport of NA, from stored NA vesicle and/or axoplasma, respectively, while the ouabain-induced ACh release is attributable to the mechanism of exocytosis, which is triggered by regional depolarization. At both sympathetic and parasympathetic nerve endings, the regional exocytosis is because of opening of calcium channels and intracellular calcium mobilization.