Autologous Transplantation of Fascia into the Vocal Fold: Long-Term Result of Type-1 Transplantation and the Future

OBJECTIVES

Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long-term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future.

STUDY DESIGN

Prospective study.

METHODS

We were able to obtain long-term results from 10 volunteer cases (2 female and 8 male, age: 15-71, mean 46.5 years old) who could be followed up for at least 3 years after transplantation. All were cases of pathologic sulcus vocalis.We measured maximum phonation time (MPT) and carried out pre- and postsurgical clinical observation and laryngeal stroboscopy in all cases. These measurements and observations were made before the ATFV and at 6 months, 1 year, 2 years, and 3 years after surgery.

RESULTS

In stroboscopic observation 1 year after the ATFV, satisfactory glottal closure and excellent mucosal wave were observed for all cases, and there was no case with hyperadduction of the false vocal folds. MPT measures remained at an improved level 2 years and 3 years after the transplantations. Paired-sample t tests showed that the improvement relative to preATFV levels was significant for all postsurgical measurements up to 3 years.

CONCLUSIONS

We conclude that ATFV is a successful surgical procedure for sulcus vocalis and scarred vocal folds. Other phonosurgical clinical applications may also be envisioned.

[Off-pump coronary artery bypass grafting as standard operation; surgical strategies and results]

We report the clinical results of 799 cases of isolated coronary artery bypass grafting (CABG) performed during the recent 5 years. We performed off-pump CABG (OPCAB) as standard operation, in which arterial grafts were mainly used. The mean number of distal anastomoses was 3.6 +/- 1.4 per patient Four hundred and fifty-five cases (57.0%) were done only with arterial grafts. Bilateral internal thoracic arteries were used in 326 cases. The mean number of saphenous vein grafts was 1.6 +/- 0.8 per patient. Continuous hemodiafiltraion (CHDF) was performed in 22 cases (2.8%) postoperatively. Among the OPCAB cases, 10 cases (1.3%) were converted to on-pump CABG. There were 7 cases (0.9%) of hospital death. The mean length of postoperative hospital stay was 10.2 +/- 5.3 days. The ratio of the patients with left main trunk disease and that of the patients who required postoperative CHDF increased year by year. The mean length of postoperative hospital stay decreased every year, and the reduced length was 2.7 days in the 5 years (8.7+/- 3.6 days in 2007). It is expected that patients who have severe calcified lesions or who are on hemodialysis may increase in the near future. In such cases, CABG rather than percutaneous catheter intervention may be suitable for revascularization. Therefore, not only appropriate choice of treatment strategies, but also accurate surgical techniques may become more importance.

OmpA is an adhesion factor of Aeromonas veronii, an optimistic pathogen that habituates in carp intestinal tract

AIMS

In the present study, we focused on one of the Aeromonas veronii isolates that exhibited marked adhesion onto carp intestine and studied its membrane-associated proteins for their possible involvement in mucosal adhesion.

METHODS AND RESULTS

We isolated a strain of Aer. veronii (CWP11) that exhibited a high degree of temperature-dependent adhesion activity onto carp intestinal tract and studied its adhesion factor. A proteomic analysis of the membrane-associated fraction showed the presence of multiple proteins that were specifically expressed in CWP11 cells cultured at 25 degrees C. Of these, a 30 kDa protein was identified to be OmpA by a mass fingerprint analysis. Cloning and nucleotide sequencing of the ompA region of CWP11 revealed the presence of two tandem ompA homologues (ompAI-ompAII). Escherichia coli that expressed either OmpAI or OmpAII exhibited marked adhesion onto carp intestinal surface. Disruption of ompAI by a homologous recombination technique resulted in marked reduction of the adhesion activity in CWP11.

CONCLUSION

The OmpA homologue plays an important role in the adhesion of the Aer. veronii strain onto the surface of intestinal tract.

SIGNIFICANCE AND IMPACT OF THE STUDY

We successfully identified an OmpA homologue to be an adhesion factor of Aer. veronii, an optimistic pathogen that habituates in carp intestinal tract.

Phylogenetic analysis of intestinal bacteria and their adhesive capability in relation to the intestinal mucus of carp

AIMS

The aims of the present study are to characterize the intestinal microbial community displaying a high-adhesive capability in fish, and to evaluate the relationship between mucosal adhesion of intestinal bacteria and fish health and disease.

METHODS AND RESULTS

A total of 707 aerobic bacteria isolated from carp intestine that were maintained under either feeding (feeding group) or no-feeding (no-feeding group) conditions and were performed adhesive assay. Isolates were divided into three categories on the basis of adhesive capability: high-, medium-, and low- adhesive capabilities. The average proportions of isolates with high-adhesive capability in the feeding and no-feeding groups were 30% and 32%, respectively. A phylogenetic analysis using a partial 16S rRNA gene demonstrated that most isolates with high-adhesive capability in both groups were classified as belonging to an Aeromonas group, and populations of isolates within high- and low-adhesive categories were markedly different.

CONCLUSIONS

Intestinal bacteria with a high-adhesive capability in relation to intestinal mucous always colonize on the surface of intestinal mucosa and grow in the intestinal tract of feeding carp. The adhesive capability of intestinal bacteria is essential for colonization and growth in the intestinal tract of fish.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results indicate that members of the Aeromonas group with adhesive capability always colonize on the surface of intestinal mucosa.

Mobile phone base station radiation does not affect neoplastic transformation in BALB/3T3 cells

A large-scale in vitro study focusing on low-level radiofrequency (RF) fields from mobile radio base stations employing the International Mobile Telecommunication 2000 (IMT-2000) cellular system was conducted to test the hypothesis that modulated RF fields affect malignant transformation or other cellular stress responses. Our group previously reported that DNA strand breaks were not induced in human cells exposed to 2.1425 GHz Wideband Code Division Multiple Access (W-CDMA) radiation up to 800 mW/kg from mobile radio base stations employing the IMT-2000 cellular system. In the current study, BALB/3T3 cells were continuously exposed to 2.1425 GHz W-CDMA RF fields at specific absorption rates (SARs) of 80 and 800 mW/kg for 6 weeks and malignant cell transformation was assessed. In addition, 3-methylcholanthrene (MCA)-treated cells were exposed to RF fields in a similar fashion, to assess for effects on tumor promotion. Finally, the effect of RF fields on tumor co-promotion was assessed in BALB/3T3 cells initiated with MCA and co-exposed to 12-O-tetradecanoylphorbol-13-acetate (TPA). At the end of the incubation period, transformation dishes were fixed, stained with Giemsa, and scored for morphologically transformed foci. No significant differences in transformation frequency were observed between the test groups exposed to RF signals and the sham-exposed negative controls in the non-, MCA-, or MCA plus TPA-treated cells. Our studies found no evidence to support the hypothesis that RF fields may affect malignant transformation. Our results suggest that exposure to low-level RF radiation of up to 800 mW/kg does not induce cell transformation, which causes tumor formation.

Replication study for the association of TCF7L2 with susceptibility to type 2 diabetes in a Japanese population

AIMS/HYPOTHESIS

The transcription factor 7-like 2 gene (TCF7L2) has been shown to be strongly associated with an increased risk of type 2 diabetes in white populations. To further investigate the involvement of TCF7L2 in conferring susceptibility to type 2 diabetes, we examined the association of TCF7L2 polymorphisms with type 2 diabetes in a Japanese population.

SUBJECTS AND METHODS

We analysed four SNPs (rs12255372, rs7903146, rs7901695 and rs11196205) and one tetranucleotide repeat polymorphism (DG10S478) in 1,630 Japanese subjects with type 2 diabetes and 1,064 control subjects.

RESULTS

All investigated polymorphisms were significantly associated with type 2 diabetes, and rs12255372 showed the strongest association (T vs G, chi2 = 9.20, p = 0.0024, odds ratio = 1.70, 95% CI = 1.20-2.41), although the frequency of the risk allele in our population was much lower than that in white populations. The microsatellite polymorphism showed an almost complete linkage disequilibrium to rs1255372 when the alleles with longer repeats (+8, +12) were considered as minor alleles and showed an association with type 2 diabetes (chi2 = 5.34, p = 0.021, odds ratio = 1.50, 95% CI = 1.06-2.12).

CONCLUSIONS/INTERPRETATION

These results indicate that TCF7L2 might be a strong candidate for conferring susceptibility to type 2 diabetes across different ethnicities.

Surgical resection of solitary adrenal metastasis from esophageal carcinoma following esophagectomy

The prognosis of esophageal carcinoma following esophagectomy is poor due to a high frequency of metastasis to periesophageal lymph nodes and distant organs. However, we experienced a case with good prognosis following resection of a solitary adrenal metastatic tumor. The patient was a 70-year-old man diagnosed with type 2 esophageal cancer (Lt-Ae, T2N1M0, Stage IIB) who was treated with esophagectomy. Eight months following surgery, solitary adrenal metastasis was detected by CT, and was resected. At 42 months follow-up he has had a good quality of life in the community without evidence of recurrence. To the best of our knowledge, only five cases with resected solitary adrenal metastases including our case, have been reported, and show a greater than 1-year survival. Consequently, we suggest that resection of solitary organ metastases is a good alternative, even following esophagectomy.

Mobile phone base station-emitted radiation does not induce phosphorylation of Hsp27

An in vitro study focusing on the effects of low-level radiofrequency (RF) fields from mobile radio base stations employing the International Mobile Telecommunication 2000 (IMT-2000) cellular system was conducted to test the hypothesis that modulated RF fields act to induce phosphorylation and overexpression of heat shock protein hsp27. First, we evaluated the responses of human cells to microwave exposure at a specific absorption rate (SAR) of 80 mW/kg, which corresponds to the limit of the average whole-body SAR for general public exposure defined as a basic restriction in the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines. Second, we investigated whether continuous wave (CW) and Wideband Code Division Multiple Access (W-CDMA) modulated signal RF fields at 2.1425 GHz induced activation or gene expression of hsp27 and other heat shock proteins (hsps). Human glioblastoma A172 cells were exposed to W-CDMA radiation at SARs of 80 and 800 mW/kg for 2-48 h, and CW radiation at 80 mW/kg for 24 h. Human IMR-90 fibroblasts from fetal lungs were exposed to W-CDMA at 80 and 800 mW/kg for 2 or 28 h, and CW at 80 mW/kg for 28 h. Under the RF field exposure conditions described above, no significant differences in the expression levels of phosphorylated hsp27 at serine 82 (hsp27[pS82]) were observed between the test groups exposed to W-CDMA or CW signal and the sham-exposed negative controls, as evaluated immediately after the exposure periods by bead-based multiplex assays. Moreover, no noticeable differences in the gene expression of hsps were observed between the test groups and the negative controls by DNA Chip analysis. Our results confirm that exposure to low-level RF field up to 800 mW/kg does not induce phosphorylation of hsp27 or expression of hsp gene family.

[A case of quadruple cancers of esophagus, stomach, lung and buccal mucosa improving the quality of life by loco-regional cancer therapy]

The patient is an 86-year-old man who was presented with right submandibular mass and tarry stool. He was diagnosed having right buccal carcinoma with right cervical lymph node metastasis, gastric cancer with double lesions, and suspected right superior lung cancer by endoscopy and computed tomography. We started with an operation for the right buccal carcinoma. After the operation, superficial-esophageal carcinoma was found. Due to his old age and a lack of physical strength in the operation, we performed an endoscopic mucosal resection for esophageal cancer and argon plasma coagulation for gastric cancer. Symptomatic therapy was only performed for lung cancer. He died from lung cancer 18 months later. However, he had a good quality of life during the progress without recurrence, and the gastric cancer was also controllable without symptoms. It was difficult to decide the treatment for duplicated multiple organ cancers caused by numerous factors such as in our case. We assume that patient's quality of life is the most appropriate factor to be considered in selecting the treatment for elderly patients.

Electromyography of the cricoarytenoid unit during supracricoid laryngectomy with a cricohyoidoepiglottopexy procedure

Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved.

Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.

Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study

OBJECTIVE

In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective.

METHODS

The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer.

RESULTS

Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions.

CONCLUSION

The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context.

PRACTICE IMPLICATIONS

We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.

Phosphorylation and gene expression of p53 are not affected in human cells exposed to 2.1425 GHz band CW or W-CDMA modulated radiation allocated to mobile radio base stations

A large-scale in vitro study focusing on low-level radiofrequency (RF) fields from mobile radio base stations employing the International Mobile Telecommunication 2000 (IMT-2000) cellular system was conducted to test the hypothesis that modulated RF fields induce apoptosis or other cellular stress response that activate p53 or the p53-signaling pathway. First, we evaluated the response of human cells to microwave exposure at a specific absorption rate (SAR) of 80 mW/kg, which corresponds to the limit of the average whole-body SAR for general public exposure defined as a basic restriction by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines. Second, we investigated whether continuous wave (CW) and wideband code division multiple access (W-CDMA) modulated signal RF fields at 2.1425 GHz induced apoptosis or any signs of stress. Human glioblastoma A172 cells were exposed to W-CDMA radiation at SARs of 80, 250, and 800 mW/kg, and CW radiation at 80 mW/kg for 24 or 48 h. Human IMR-90 fibroblasts from fetal lungs were exposed to both W-CDMA and CW radiation at a SAR of 80 mW/kg for 28 h. Under the RF field exposure conditions described above, no significant differences in the percentage of apoptotic cells were observed between the test groups exposed to RF signals and the sham-exposed negative controls, as evaluated by the Annexin V affinity assay. No significant differences in expression levels of phosphorylated p53 at serine 15 or total p53 were observed between the test groups and the negative controls by the bead-based multiplex assay. Moreover, microarray hybridization and real-time RT-PCR analysis showed no noticeable differences in gene expression of the subsequent downstream targets of p53 signaling involved in apoptosis between the test groups and the negative controls. Our results confirm that exposure to low-level RF signals up to 800 mW/kg does not induce p53-dependent apoptosis, DNA damage, or other stress response in human cells.

Long-Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy

OBJECTIVE

The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.

STUDY DESIGN AND METHODS

In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold.

RESULTS

This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery.

CONCLUSIONS

This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.

Simultaneous operation of ischemic heart disease, abdominal aortic aneurysm, and rectal cancer

A 68-year-old man with ischemic heart disease, abdominal aortic aneurysm, and rectal cancer was referred. Coronary angiography indicated triple-vessel disease with jeopardized collaterals, and dipyridamole myocardial scintigraphy disclosed no viability in the inferior, posterior, and lateral walls. Abdominal computed tomography scanning revealed an infrarenal abdominal aortic aneurysm, 65 mm in diameter, with an expanding rate of 8 mm/year. Barium enema revealed stenosis 4 cm in length 5 cm inward from the anal verge, and an endoscopic finding was ulcerated type tumor with a clear margin and circumferential stenosis. Histological examination of a biopsy specimen revealed adenocarcinoma, and the clinical stage in the Japanese classification of colorectal carcinoma was II according to other examinations. Simultaneous operations were scheduled because of the jeopardized collaterals of the coronary arteries, rapid expansion of the aneurysm, and subileus due to the cancer. The patient underwent simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery with the in situ internal thoracic artery through a median sternotomy, abdominal aortic aneurysm repair with a tube graft through a median laparotomy, and the Miles' operation with total mesorectal excision. Although infection of the perineal wound was postoperatively recognized, it remained local and was healed with irrigation only. The patient is doing well 12 months after the operation, without myocardial ischemic symptoms or recurrence of the cancer.

Endoscopic vocal cord medialization: a new surgical technique without neck incision for laryngeal palsy

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.

Surgical outcome of elephant-trunk anastomosis between the left carotid and subclavian arteries in aortic arch repair including the postoperative physical status of the left arm

We studied the outcome of our modified aortic arch replacement procedure in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery including the postoperative physical status of the left arm in comparison with the conventional technique. We assessed the surgical outcome of 26 patients who underwent our new technique and 11 patients who underwent the conventional one. Postoperative clinical symptoms and physical status of the left arm were also evaluated. No operative deaths were observed in the new technique group and one operative death was observed in the conventional group (9.1%). No significant differences between the two groups in postoperative clinical symptoms and the physical status of the left arm were observed. Our "distal anastomosis to the proximal level of the left subclavian artery" technique made aortic arch replacement easier and steadier with a satisfactory surgical outcome in comparison with the conventional method. The postoperative clinical symptoms and physical status of the left arm in the new technique group were identical to those in the conventional group.

Effects of exposure to a 1950 MHz radio frequency field on expression of Hsp70 and Hsp27 in human glioma cells

Human glioma MO54 cells were used to investigate whether radio frequency (RF) field exposure could activate stress response genes. Cells were exposed to continuous wave 1950 MHz or sham conditions for up to 2 h. Specific absorption rates (SARs) were 1, 2, and 10 W/kg. For the cell growth experiment, cell numbers were counted at 0-4 days after exposure. Expression of Hsp27 and Hsp70, as well as the level of phosphorylated Hsp27 (78Ser) protein, was determined by Western blotting. It was found that sham exposed and RF exposed cells demonstrated a similar growth pattern up to 4 days after RF field exposure. RF field exposure at both 2 and 10 W/kg did not affect the growth of MO54 cells. In addition, there were no significant differences in protein expression of Hsp27 and Hsp70 between sham exposed and RF exposed cells at a SAR of 1, 2, or 10 W/kg for 1 and 2 h. However, exposure to RF field at a SAR of 10 W/kg for 1 and 2 h decreased the protein level of phosphorylated Hsp27 (78Ser) significantly. Our results suggest that although exposure to a 1950 MHz RF field has no effect on cell proliferation and expression of Hsp 27 and Hsp70, it may inhibit the phosphorylation of Hsp27 at Serine 78 in MO54 cells.

The effect of storage on the survival of cancer cells in blood and efficient elimination of contaminating cancer cells by a leukocyte depletion filter

Preoperative autologous blood pooling has been employed in patients with malignant tumor. However, it has not been reported how the survival period of tumor cells contaminating the preoperative pooled blood changes corresponding to the storage period. Intraoperative blood salvage (IBS) is used together with preoperative blood pooling. However, IBS in oncologic surgery is generally regarded as a contraindication. In the current study, using cytokeratin 19 (CK-19) mRNA reverse transcription polymerase chain reaction method, we examined the survival period of cultured cancer cells in the pooled blood and the efficacy of irradiation and leukocyte depletion filter in eliminating cancer cells in the blood. Expression of CK-19 mRNA was observed in the pooled blood stored for 21 days. The number of cancer cells decreased to about 1/10 in the blood stored for 14 days. We irradiated blood with cancer cells with doses of 25 Gy or 100 Gy. No change was observed in the amplified CK-19 signal strength immediately after and 1 day after irradiation at 100 Gy. After filtration of blood with cancer cells through the leukocyte depletion filter, no CK-19 mRNA was detected. Blood filtration with the leukocyte depletion filter was effective in eliminating cancer cells in the blood.

The Effect of Storage on the Survival of Cancer Cells in Blood and Efficient Elimination of Contaminating Cancer Cells by a Leukocyte Depletion Filter

Preoperative autologous blood pooling has been employed in patients with malignant tumor. However, it has not been reported how the survival period of tumor cells contaminating the preoperative pooled blood changes corresponding to the storage period. Intraoperative blood salvage (IBS) is used together with preoperative blood pooling. However, IBS in oncologic surgery is generally regarded as a contraindication. In the current study, using cytokeratin 19 (CK-19) mRNA reverse transcription polymerase chain reaction method, we examined the survival period of cultured cancer cells in the pooled blood and the efficacy of irradiation and leukocyte depletion filter in eliminating cancer cells in the blood. Expression of CK-19 mRNA was observed in the pooled blood stored for 21 days. The number of cancer cells decreased to about 1/10 in the blood stored for 14 days. We irradiated blood with cancer cells with doses of 25 Gy or 100 Gy. No change was observed in the amplified CK-19 signal strength immediately after and 1 day after irradiation at 100 Gy. After filtration of blood with cancer cells through the leukocyte depletion filter, no CK-19 mRNA was detected. Blood filtration with the leukocyte depletion filter was effective in eliminating cancer cells in the blood.

A pilot study of the translation, cultural adaptation and validation of the EORTC head and neck cancer quality of life questionnaire module (QLQ-H&N35) for use in Japan

Development of the Japanese version of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-head and neck 35 (H&N35) module for use in Japan. Phase 1: The First Intermediary Japanese version was produced according to the EORTC Quality of Life (QOL) Unit translation project guideline. The Second Intermediary version was a result of the backward translation project and two peer-to-peer discussion settings by health care professionals related to the project. Phase 2: Focus group discussions with team members and semi-structured interviews with 108 participants to produce the final Japanese version. Our cultural-adaptation and validation yielded scores that are reliable by internal consistency (Cronbach's alpha) and the validation results showed acceptable correlation results by Pearson's Product Moment Correlation Coefficient (r). The questionnaire was well accepted and the response rate was high (93.9%). Convergent validity was moderate to high (from r=0.55 to 0.97, P<0.01) and discriminant validity was low; Cronbach's alpha coefficients of most scales had good reliability (alpha> or =0.70), except that of pain scale. In Japan, however, some correlation patterns between scales differed from that in the original European countries and cultures. The use of both qualitative and quantitative methods was important in developing the Japanese version of the QLQ-H&N35 module. We conclude that the Japanese version has good psychometric validity, thus it is recommended for further study to assess health-related quality of life (HRQOL) in Japanese head and neck cancer patients.

Stent placement for severe stenosis in the deep femoral artery with the occluded superficial femoral and popliteal arteries

In both superficial and deep femoral artery involvement, where angioplasty of the former is not suitable or feasible, angioplasty of the latter seems to be the method of choice and is a less invasive and efficient treatment particularly for limb threatening ischemia, an appropriate obstruction morphology provided. The authors describe a case of a 73-year-old man, with a rest pain of the foot and intermittent cyanosis of the toe, who underwent stent placement with transluminal angioplasty for severe stenosis in the deep femoral artery with the occluded superficial femoral and popliteal artery. The patient's ankle brachial index was remarkably increased from 0.25 to 0.61, and the preoperative symptoms were improved.

Looped reconstruction of the internal and external iliac arteries in repair of abdominal aortic or iliac artery aneurysm with a bifurcated graft

AIM

The aim of our study is to describe an original technique of distal anastomosis of a bifurcated graft, coining looped reconstruction, and our preliminary clinical experience.

METHODS

This technique has been applied in 16 of 24 distal anastomoses of 12 patients with abdominal aortic aneurysm (AAA) and/or iliac artery aneurysm. Both the internal (IIA) and external iliac arteries (EIA) are transected and anastomosed with end-to-end fashion to reconstruct their continuity, and the limb of a bifurcated graft is anastomosed to the EIA with end-to-side fashion.

RESULTS

Operative and in-hospital death, ischemic colitis, or ischemia of the lower extremities including blue toe syndrome has never occurred. All the 28 reconstructed IIAs and EIAs have been patent in 11 patients who could undergo early postoperative computed tomography scans with contrast medium.

CONCLUSIONS

The looped reconstruction of the IIA and the EIA in repair of an AAA and/or an iliac artery aneurysm with a bifurcated graft is an anatomically easy and technically simple method.

Translocation of Salmonella typhimurium in rats on total parenteral nutrition correlates with changes in intestinal morphology and mucus gel

OBJECTIVE

We tested whether alterations in intestinal morphology and mucus gel correlate with differences in Salmonella typhimurium translocation between rats treated with total parenteral nutrition (TPN) and rats given a diet of chow.

METHODS

Twenty-seven male Wistar rats were assigned to one of two groups: one received TPN for 14 d and the other (control) received standard rat chow and water ad libitum. Salmonella typhimurium (5 x 10(8) cells; GIFU 12142) was injected into a closed ileal loop. Portal venous blood (PVB), inferior vena cava blood (IVCB), and mesenteric lymph nodes (MLNs) were sampled for evaluation of bacterial translocation. Sections of the loop were prepared and stained with hematoxylin and eosin, periodic acid-Schiff (PAS), and fluorescein isothiocyanate-labeled Ulex europaeus agglutinin I (FITC-UEA-I) for image analysis. Perimeter, mucosal thickness, villus area, and positively stained mucus area were measured. A fluorescent antibody study was also done.

RESULTS

Organisms were found in cultures of 1 in 13 control rats and 9 in 14 TPN rats. There were more bacteria in MLNs than in PVB or IVCB. There was no increase in the number of bacteria over time in PVB, IVCB, or MLNs. Perimeter and villus area (P < 0.001) and mucosal thickness (P < 0.01) were significantly smaller in the TPN group than in the control group. The positively stained mucus area was significantly smaller in the TPN group than in the control group (P < 0.05 with PAS, P < 0.01 with FITC-UEA-I). Salmonella typhimurium invaded specifically through Peyer's patches. In all culture-negative samples, bacteria were trapped by the mucous layer, with a very small number attached to the epithelial surface.

CONCLUSION

Significant villous atrophy and reduction of mucus play an important role in the rapid translocation of S. typhimurium through Peyer's patches in rats after 2 wk of TPN.