[Tracheostenosis caused by blunt thoracic trauma]

Blunt thoracic trauma rarely implicate retropharyngeal hematoma obstructing trachea. 85-year-old woman being struck on her cheek and anterior chest, visited our emergency room. She was nearly suffocated following stridor and dyspnea. Tracheal intubation relieved her dyspnea Chest computed tomography (CT) showed retropharyngeal hematoma obstructing trachea. 5 days conservative management reduced the hematoma and tracheal tube was extubated through an uneventful course.

Right ventricular plication in a neonate with an unguarded tricuspid valvar orifice

Unguarded tricuspid orifice is a congenital cardiac malformation characterized by absence of the tricuspid valvar leaflets in the setting of a normal atrioventricular junction and obligatory severe tricuspid regurgitation. A neonate with such a lesion presented with severe cardiac failure. The right atrium and ventricle were grossly dilated, and there were small muscular ventricular septal defects. We plicated the right-sided structures to create space for adequate expansion of the lungs and left ventricular filling, proceeding to staged conversion to the Fontan circulation. Our experience shows that neonates with cardiac failure due to dilated right-sided structures can be stabilized by surgical plication.

[Indication and timing of surgical intervention for cardiovascular disease in hemodialysis dependent patients]

Surgical intervention on cardiovascular disorders in patients with hemodialysis dependent renal failure improves their life expectancy, but carries high surgical mortality. Decision on the indication of surgery as well as on its timing has crucial impact on surgical outcome. We retrospectively analyzed the data of 21 hemodialysis dependent patients who had undergone cardiovascular surgery in our institution from May 2001 to May 2005 to elucidate the appropriate indication and timing of surgical intervention. The study revealed early mortality (< 30 days) of 4.8% and 5 year survival rate of 83.5%. Risk factors for poor prognosis were older age, and longer hemodialysis history. Despite the opinions advocating early surgery in these patients, we adopted a surgical strategy to wait until patients' condition is optimized. Low surgical mortality and high long-term survival of our surgical series indicated appropriateness of our strategy on the timing of surgery. However, extremely low long-term mortality rate raised the concern that our surgical indication might have been too conservative.

Intensive cardiac management in patients with trisomy 13 or trisomy 18

Intensive cardiac management such as pharmacological intervention for ductal patency (indomethacin and/or mefenamic acid for closure and prostaglandin E1 for maintenance) and palliative or corrective surgery is a standard treatment for congenital heart defects. However, whether it would be a treatment option for children with trisomy 13 or trisomy 18 syndrome is controversial because the efficacy on survival in patients with these trisomies has not been evaluated. We retrospectively reviewed 31 consecutive neonates with trisomy 13 or trisomy 18 admitted to our neonatal ward within 6 hr of birth between 2000 and 2005. The institutional management policies differed during three distinct periods. In the first period, both pharmacological ductal intervention and cardiac surgery were withheld. In the second, pharmacological ductal intervention was offered as an option, but cardiac surgery was withheld. Both strategies were available during the third period. The median survival times of 13, 9, and 9 neonates from the first, second, and third periods were 7, 24, and 243 days, respectively. Univariate and multivariate analyses confirmed that the patients in the third period survived significantly longer than the others. Intensive cardiac management consisting of pharmacological intervention for ductal patency and cardiac surgery was demonstrated to improve survival in patients with trisomy 13 or trisomy 18 in this series. Therefore, we suggest that this approach is a treatment option for cardiac lesions associated with these trisomies. These data are helpful for clinicians and families to consider in the optimal treatment of patients with these trisomies.

A novel method for measuring human lipoprotein lipase and hepatic lipase activities in postheparin plasma

The objective of this study was to establish a new lipoprotein lipase (LPL) and hepatic lipase (HL) activity assay method. Seventy normal volunteers were recruited. Lipase activities were assayed by measuring the increase in absorbance at 546 nm due to the quinoneine dye. Reaction mixture-1 (R-1) contained dioleoylglycerol solubilized with lauryldimethylaminobetaine, monoacylglycerol-specific lipase, glycerolkinase, glycerol-3-phosphate oxidase, peroxidase, ascorbic acid oxidase, and apolipoprotein C-II (apoC-II). R-2 contained Tris-HCl (pH 8.7) and 4-aminoantipyrine. Automated assay of lipase activities was performed with an automatic clinical analyzer. In the assay for HL + LPL activity, 160 microl R-1 was incubated at 37 degrees C with 2 microl of sample for 5 min, and 80 microl R-2 was added. HL activities were measured under the same conditions without apoC-II. HL and LPL activities were also measured by the conventional isotope method and for HL mass by ELISA. Lipase activity detected in a 1.6 M NaCl-eluted fraction from a heparin-Sepharose column was enhanced by adding purified apoC-II in a dose-dependent manner, whereas that eluted by 0.8 M NaCl was not. Postheparin plasma-LPL and HL activities measured in the present automated method had high correlations with those measured by conventional activity and mass methods. This automated assay method for LPL and HL activities is simple and reliable and can be applied to an automatic clinical analyzer.

Light-guided surgery to repair coronary sinus orifice atresia with left superior vena cava

An 8-month-old male with coronary sinus orifice atresia, left superior vena cava, and single ventricle underwent light-guided coronary sinus unroofing concomitant with bidirectional cavopulmonary anastomosis to circumvent coronary sinus hypertension. During surgery, a 2.25 Fr angioscopic catheter was inserted into the coronary sinus via the left superior vena cava. The coronary sinus, lit by the illumination obtained from the catheter, was readily located from the left atrial interior, and unroofed. Light-guided coronary sinus unroofing is an easy, safe, and quick technique for the creation of unobstructed coronary sinus drainage in patients with coronary sinus orifice atresia and left superior vena cava.

[Primary arterial switch operation for complete transposition of the great arteries (type I) of a neonate weighing 1,378 g]

A 2-day-old female baby, delivered by emergent cesarean section at 35 weeks of gestational age with a birth weight of 1,378 g, was referred to our institute for intensive care of heart failure. By echocardiography and cardiac catheterization, the patient was diagnosed with isolated complete transposition of the great arteries. Primary arterial switch operation was performed at 13 days of age. No technical difficulty arose, imposed by the small size of cardiovascular structure. On the 5th postoperative day, surgical repair of intestinal perforation was performed. Convalescence thereafter was uneventful. She returned home on the 64th postoperative day with the body weight of 2,310 g. We conclude that primary arterial switch operation can be a feasible surgical option even in a neonate with very low birth weight.

The relationship of serum lipoprotein lipase mass with fasting serum apolipoprotein B-48 and remnant-like particle triglycerides in type 2 diabetic patients

BACKGROUND

There have been no previous reports showing specifically the relation between lipoprotein lipase (LPL) and apolipoprotein (apo) B-48 or remnant metabolism. In this study, we have clarified the relationships of LPL mass in pre-heparin with serum apo B-48 measured by enzyme-linked immunosorbent assay, triglycerides (TG), and remnant-like particle triglycerides (RLP-TG).

MATERIAL AND METHODS

Seventy-nine type 2 diabetic subjects [age, 55+/-13; body mass index (BMI), 25+/-5.0 kg/m2; fasting plasma glucose (FPG), 7.39+/-2.22 mmol/l, HbA1c, 6.5+/-1.3%, total cholesterol (TC), 5.36+/-1.09 mmol/l, TG, 2.32+/-2.53 mmol/l; HDL-C, 1.22+/-0.44 mmol/l; serum LPL mass, 45+/-22 ng/ml; apo B-48, 6.6+/-6.3 microg/ml] were recruited in this study. Fasting serum apo B-48 were measured by ELISA using anti-human apo B-48 monoclonal antibodies (MoAb) and LPL mass by ELISA using anti-bovine milk LPL MoAb. RLP-TG levels were measured using monoclonal antibodies to apo B-100 and apo A-1.

RESULTS

There was no relationship of LPL mass to age, BMI, FPG, and HbA1c. Serum LPL mass was correlated inversely with TG (r=-0.529 p<0.0001) and positively with HDL-C (r=0.576, p<0.0001). Also, LPL mass showed inverse correlations with apo B-48 (r=-0.383 p<0.0001) and RLP-TG (r=-0.422 p<0.0001, n=51). Multiple regression analysis with TG, apo B-48, or RLP-TG as dependent variables, and age, gender, BMI, plasma glucose, and LPL mass as independent variables showed that LPL mass was associated independently with TG, apo B-48, or RLP-TG.

CONCLUSION

The decrease in LPL protein mass could cause an increase in serum apo B-48 and RLP-TG levels, which is related to the retardation of remnant metabolism.

Stenting for chronic total occlusion of the proximal subclavian artery

SUMMARY

We report the results of 26 patients who underwent stent deployment for chronic total occlusion of proximal subclavian artery. From January 1998 to October 2005, 26 patients (18 male; mean age, 62.7 years, range 22 to 83 years), 28 lesions, underwent 29 procedures of stenting for chronic total occlusion of the proximal subclavian artery.Twenty-three patients had symptoms of claudication in their arm, no patients had subclavian steal syndrome.A brachial approach was used in 21 procedures, a femoral approach was used in five procedures, and combined femoral-brachial approach was required in three procedures. Primary stent deployment was success in 24 lesions (85.7%), and secondary procedure was success in one patient, totally 25 lesions (89.3%) were successfully treated by stenting. Procedure related complication occurred in four cases, including stent migration without symptoms in two procedures, hemianopsia on next day in a case, and TIA on unclear reason in one case. Permanent morbidity rate is 3.4% in procedure. Target lesion re-treatment required in three lesions, caused by subacute thrombosis, in-stent-restenosis, and dissection of the vessel by stent edge. The cases of subacute thrombosis and in-stent-restenosis were treated by re-PTA, and the case of dissection was treated by additional stenting. Secondary patency was 100%. We conclude that stenting for chronic total occlusion of subclavian arteries appears feasible and safe.

An outbreak of psittacosis in a bird park in Japan

An outbreak of psittacosis related to a bird park occurred in Matsue City, Shimane Prefecture, Japan, during winter 2001. Seventeen cases of psittacosis (12 visitors, three staff, and two student interns) were confirmed. A cohort study was conducted among the park staff and students to determine the risk factors for the development of acute serologically confirmed psittacosis (SCP) infection. Being 'bird staff' had an increased risk of SCP infection (RR 3.96, 95% CI 1.48-10.58). Entering the staff building, where ill birds were maintained without proper isolation, was also associated with an increased risk of SCP infection (RR 3.61, 95% CI 1.03-12.6). Isolation of ill birds and quarantine measures were found to be insufficient. Dehumidifiers and a high-pressure water spray under a closed ventilation environment may have raised the concentration of Chlamydophila psittaci in the hothouses. Bird park staff and visitors should be educated about psittacosis.

Homologous recombination repair is regulated by domains at the N- and C-terminus of NBS1 and is dissociated with ATM functions

The proteins responsible for radiation sensitive disorders, NBS1, kinase ataxia-telangiectasia-(A-T)-mutated (ATM) and MRE11, interact through the C-terminus of NBS1 in response to the generation of DNA double-strand breaks (DSBs) and are all implicated in checkpoint regulation and DSB repair, such as homologous recombination (HR). We measured the ability of several NBS1 mutant clones and A-T cells to regulate HR repair using the DR-GFP or SCneo systems. ATM deficiency did not reduce the HR repair frequency of an induced DSB, and it was confirmed by findings that HR frequencies are only slightly affected by deletion of ATM-binding site at the extreme C-terminus of NBS1. In contrast, The HR-regulating ability is dramatically reduced by deletion of the MRE11-binding domain at the C-terminus of NBS1 and markedly inhibited by mutations in the FHA/BRCT domains at the N-terminus. This impaired capability in HR is consistent with a failure to observe MRE11 foci formation. Furthermore, normal HR using sister chromatid was completely inhibited by the absence of FHA/BRCT domains. These results suggested that the N- and C-terminal domains of NBS1 are the major regulatory domains for HR pathways, very likely through the recruitment and retention of the MRE11 nuclease to DSB sites in an ATM-independent fashion.

Revascularization procedure mainly by suction thrombectomy for acute cervical carotid occlusion

SUMMARY

In many cases, the prognosis for acute cervical carotid artery occlusion is poor. However, a standard treatment for the acute stage is not yet established. We report here the results of eight consecutive patients (mean age 71.5 years old) in which revascularization mainly by suction thrombectomy was performed under proximal protection during the acute phase. The occlusion sites were the intracranial internal carotid artery in five patients, tandem lesions of the internal carotid origin and intracranial vessel in two patients, and the common carotid artery in one patient. In addition, the subjects who received the treatment had an extent of infarction in MRI/DWI that was 1/3 or less of the internal carotid artery territory. The mean time from the onset to treatment commencement was 7.25 hours (2-28 hours). For the endovascular treatment, a guiding catheter with a balloon was used for proximal protection of the carotid artery. Revascularization was performed mainly by suction thrombectomy, and if a stenosed lesion was observed, PTA/stenting was added. Local fibrinolysis was not performed in combination with the above procedure. The treatment results were complete recanalization in three patients and partial recanalization in three patients. However, recanalization was not achieved in two patients. No hyperfusion syndrome or hemorrhagic infarction was observed postoperatively. All four patients in whom thrombi were successfully aspirated had occlusions proximal to the ophthalmic artery branch. In three of these four patients, complete recanalization was achieved. The revascularization procedure using suction thrombectomy under proximal protection was considered effective against the acute cervical carotid occlusions, in particular, those proximal to the ophthalmic artery branch.

A new method for identifying rigid link models of lower limbs

A new method for identifying rigid link models of human lower limbs has been proposed in this paper. The method was motivated by necessity of simulating human body movements for rehabilitation or for design of assistive devices. The method is based on combination of random search and least squares estimation techniques. Simulation and experimental results are given to illustrate the effectiveness of the proposed method.

Maintenance behaviour and long-lasting insecticide-treated nets (LLITNs) previously introduced into Bourapar district, Khammouane province, Lao PDR

BACKGROUND

Long-lasting insecticide-treated nets (LLITNs) are expected to be an important advance in malaria control, but operational experience is still scarce. This study presents some operational findings concerning the introduction of Olyset LLITNs (Sumitomo Chemical Co., Ltd, Japan) in Laos. The study site, Bourapar district, a remote district at high risk of malaria, received Olyset nets during 1999-2000. After distribution of the nets the number of malaria cases in the district hospital decreased for a time, however it began to rise again a year after the intervention. To sustain the effect of the nets, net users were given instructions on maintenance and use. This study aimed to investigate the condition of Olyset nets and the maintenance behaviour of net users after 2-3 years of use, and to examine the associations between maintenance behaviour and the number of malaria episodes during the previous year.

METHODS

Questionnaire interviews and inspections of nets were conducted at 240 households during February-March 2003.

RESULTS

About 40% of the observed nets had holes/were torn, and the maintenance instructions had not been followed sufficiently. Households following the recommended washing frequency (38.2%) reported fewer malaria episodes during the past year, which demonstrates the importance of the recommended washing frequency in the effective use of the nets.

CONCLUSIONS

Our study promotes the idea that, in addition to pursuing high coverage of LLITNs, more effort should be made to ensure that nets are kept in good condition in future LLITN programmes.

14 MOTILITY AND FERTILITY OF BULL SPERMATOZOA FROZEN IN EGG YOLK EXTENDER SUPPLEMENTED WITH LACTOFERRIN

Lactoferrin (Lf) is secreted by the prostate, seminal vesicles, and epididymis, and appears to represent a major component of the sperm-coating antigens that protect sperm. The aim of this study was to determine the effects of Lf used in semen extender on motility and fertility of bovine frozen semen. Semen samples were collected from three fertile Japanese Black sires. The semen collected was cooled and extended with egg yolk–Tris extender supplemented with glycerol and Lf (from bovine milk) to give final concentrations of 7% and 0, 10, 100, 500, 1000, or 2000 �g mL-1, respectively. After being extended, the semen was packaged in 0.5-mL straws, frozen, and transferred into liquid nitrogen. At least one week later, the frozen semen was thawed and washed mTALP containing caffeine. Motile sperm were separated by discontinuous 2-step (40 and 80%) Percoll gradient centrifugation. Sperm motility was calculated as the percentage of motile sperm separated by Percoll gradients relative to pre-separated sperm. Sperm motility character (motile sperm, progressive sperm) was analyzed by a CASA system (Hamilton Thorne Biosciences, Beverly, MA, USA). In the following experiment, we examined the effect of Lf added in the extender on improvement of semen fertility. The frozen semen from one sire extended with or without 500 �g mL-1 of Lf was prepared (99 straws with Lf, 99 straws without), distributed to three inseminators, and used to inseminate to 198 cows. The sperm motility and motility character were analyzed by ANOVA and Fisher&apos;s exact test. The field trials were evaluated by chi-square test. After selection of motile sperm with the Percoll gradient, examination of sperm motility revealed that addition of Lf in the extender increased sperm motility significantly (P &lt; 0.05) compared to that in the control without Lf: 51.2–53.8% in semen with added Lf (100–2000 �g mL-1) vs. 39.6% in the control. CASA analysis showed that motile sperm and progressive sperm were improved significantly by the addition of Lf; the peak level was 500 �g mL-1 of Lf in the extender. The percentage of motile sperm in semen with added Lf was higher significantly (P &lt; 0.01) than that of the control: with Lf of 100 and 500 �g mL-1, 50.8 and 56.0%, respectively, vs. 39.7% without Lf. The percentage of progressive sperm was also significantly higher (P &lt; 0.05) than that of the control: with Lf of 100 and 500 �g mL-1, 18.8 and 19.0%, respectively, vs. 13.5% without Lf. In the next experiment, we performed field trials to assess the availability of Lf for artificial insemination. In total, the group with Lf showed some but not a significant increase in fertility rate (delivery cow/inseminated cow) compared with the control group without Lf: 56.6% vs. 52.5%, respectively. In conclusion, these results suggest that addition of Lf in sperm extender may be useful for improvement of sperm motility and motility character after freezing and thawing. In the present study, we used fertile bulls, but the concentration of intact Lf in the semen was unknown, which might be the reason why the effect of Lf on the fertility rate was not observed to be significant. In future experiments it would be valuable to demonstrate the effect of Lf in subfertile semen.