Sclerosing therapy of internal hemorrhoids with a novel sclerosing agent. Comparison with ligation and excision

BACKGROUND AND AIMS

Patients with prolapsing internal hemorrhoids were treated with a novel sclerosing agent (OC-108), and the results were compared with surgery of ligation and excision.

PATIENTS AND METHODS

This study included 20 years or older patients with prolapsing internal hemorrhoids who visited ten medical institutions in Japan from October 2000 to October 2002. Investigation on surgery was also performed.

RESULTS

Comparing OC-108 and surgery in patients with third- and fourth-degree internal hemorrhoids according to the Goligher's classification, for which surgery has been generally indicated, at 28 days after treatment, the disappearance rate of prolapse was similar between OC-108 and surgery, 94% (75/80 patients) and 99% (84/85 patients), respectively. The 1-year recurrence rate was 16% (12/73 patients) in the OC-108 group, and this value was satisfactory because of its less invasive nature while it was more or less higher compared with 2% (2/81 patients) in the surgery group. The incidences of pain and bleeding were lower in the OC-108 group.

CONCLUSIONS

OC-108 is a useful alternative treatment for hemorrhoids.

Female-specific neuroprotection against transient brain ischemia observed in mice devoid of prion protein is abolished by ectopic expression of prion protein-like protein

This study was designed to examine the function of cellular prion protein and prion protein-like protein/Doppel, in transient ischemia-related neuronal death in the hippocampus. Two different lines of mice devoid of cellular prion protein, Zrch I Prnp(0/0) and Ngsk Prnp(0/0), were used. The former lacks cellular prion protein whereas the latter ectopically expresses prion protein-like protein/Doppel in the brain in the absence of cellular prion protein. Mice were subjected to 10 min-occlusion of the bilateral common carotid arteries with recovery for 14 days. Less than 10% of the pyramidal neurons in the CA1 subfield were degenerated in male and female wild-type mice. In contrast, more than half of the neurons were lost in male Zrch I Prnp(0/0) and Ngsk Prnp(0/0) mice. Such severe neuronal loss was also observed in female Ngsk Prnp(0/0) mice. However, female Zrch I Prnp(0/0) mice showed mild neuronal loss similar to wild-type mice. Flunarizine, a T- and L-type Ca(2+)-channel antagonist, significantly reduced the neuronal loss in female but not in male Ngsk Prnp(0/0) mice. These results indicate that loss of cellular prion protein renders hippocampal neurons susceptible to ischemic insult specifically in male but not female mice and the ectopic expression of prion protein-like protein/Doppel aggravates the ischemic neuronal death in female prion protein-null mice probably via overloading of Ca(2+)-dependent signaling.

A Ramsey's Method With Pulsed Neutrons for a T-Violation Experiment

A Ramsey's method with pulsed neutrons is discussed for neutron spin manipulation in a time reversal (T) symmetry violation experiment. The neutron spin (s n) is aligned to the direction of a vector product of the nuclear spin ( I ) and the neutron momentum ( k n) for the measurement of a T-odd correlation term, which is represented as s n · ( k n × I ), during propagation through a polarized nuclear target. The phase control and amplitude modulation of separated oscillatory fields are discussed for the measurement of the T-odd correlation term.

Japanese patients' preferences for receiving cancer test results while in the United States: introducing an advance directive for cancer disclosure

BACKGROUND

While disclosure of cancer is routine in the United States, it is not in Japan. The primary goals of this investigation were to describe overseas Japanese patients' preferences for participation in decisions about cancer; to delineate patients' beliefs about how physicians should make cancer disclosure decisions; and to assess patients' attitudes about a advance directive for cancer disclosure.

METHODS

This ethnography utilized data from participant observations, 30 interviews, and lay materials. Using the analytic technique of immersion and crystallization the data were organized around major themes and subthemes.

RESULTS

The mean age of the 30 participants was 38 years and most (n = 20) were female. While most patients expressed preferences to be told the results of cancer testing, the number who did not want to be told increased with more advanced cancer stage. Many participants believed decisions about disclosure should be influenced by a patient's personality, age, or gender, although the relative importance of these factors was variable. Virtually all believed circumstances existed when fully competent patients should not be told the cancer diagnosis. Most participants were supportive of using an advance directive for cancer disclosure.

DISCUSSION

These participants' beliefs about many aspects of the management of cancer test results differ from recommended approaches to conveying cancer test results and discussing the cancer diagnosis in the United States. Most encourage the use of an advance directive for cancer disclosure as mechanism for physicians to elicit patients' unique preferences for participation in decision making about cancer.

Measurement of Parity Violation in np Capture: the NPDGamma Experiment

The NPDGamma experiment will measure the parity-violating directional gamma ray asymmetry A γ in the reaction [Formula: see text]. Ultimately, this will constitute the first measurement in the neutron-proton system that is sensitive enough to challenge modern theories of nuclear parity violation, providing a theoretically clean determination of the weak pion-nucleon coupling. A new beam-line at the Los Alamos Neutron Science Center (LANSCE) delivers pulsed cold neutrons to the apparatus, where they are polarized by transmission through a large volume polarized (3)He spin filter and captured in a liquid para-hydrogen target. The 2.2 MeV gamma rays from the capture reaction are detected in an array of CsI(Tl) scintillators read out by vacuum photodiodes operated in current mode. We will complete commissioning of the apparatus and carry out a first measurement at LANSCE in 2004-05, which would provide a statistics-limited result for A γ accurate to a standard uncertainty of ±5 × 10(-8) level or better, improving on existing measurements in the neutron-proton system by a factor of 4. Plans to move the experiment to a reactor facility, where the greater flux would enable us to make a measurement with a standard uncertainty of ±1 × 10(-8), are actively being pursued for the longer term.

Commissioning of the NPDGamma Detector Array: Counting Statistics in Current Mode Operation and Parity Violation in the Capture of Cold Neutrons on B 4 C and (27) Al

The NPDGamma γ-ray detector has been built to measure, with high accuracy, the size of the small parity-violating asymmetry in the angular distribution of gamma rays from the capture of polarized cold neutrons by protons. The high cold neutron flux at the Los Alamos Neutron Scattering Center (LANSCE) spallation neutron source and control of systematic errors require the use of current mode detection with vacuum photodiodes and low-noise solid-state preamplifiers. We show that the detector array operates at counting statistics and that the asymmetries due to B4C and (27)Al are zero to with- in 2 × 10(-6) and 7 × 10(-7), respectively. Boron and aluminum are used throughout the experiment. The results presented here are preliminary.

Reductions in levels of bacterial superantigens/cannabinoids by plasma exchange in a patient with severe toxic shock syndrome

Toxic shock syndrome is a rare but potentially fatal toxin-mediated febrile illness. We report a case of toxic shock syndrome complicated by life-threatening organ dysfunction with high toxin-1 and staphylococcus enterotoxin type A levels that were successfully reduced by early introduction of plasma exchanges. The report shows the time course of the concentrations of anandamide and 2-arachidonyl glyceride and confirms that early introduction of plasma exchange can result in a rapid reduction of circulating toxins and mediators in the treatment of life-threatening multiple organ dysfunction.

Antinociceptive efficacy of antidepressants: assessment of five antidepressants and four monoamine receptors in rats

PURPOSE

For assessment of the antinociceptive potency of antidepressants, we compared the antinociceptive effects of serotonin selective reuptake inhibitors (SSRIs) and classical tricyclic antidepressants (TCAs) in rats. We also attempted to elucidate the monoamine receptor subtypes predominantly involved in the antinociceptive effect of antidepressants.

METHODS

Male Wistar rats received SSRIs (sertraline, fluvoxamine, and citalopram) or TCAs (imipramine and desipramine) intraperitoneally, and the reaction time until pain response in the hot plate test and licking time in the formalin test were measured 60 min later. We also observed the effects of prazosin (an alpha(1) antagonist), WB-4101 (a selective alpha(1A) antagonist), yohimbine (an alpha(2) antagonist), WAY-100635 (a selective 5-HT(1A) antagonist), and ketanserin (a 5-HT(2) antagonist), which were simultaneously administered with imipramine or desipramine, on the antidepressant-induced antinociceptive effect in the formalin test.

RESULTS

In the hot plate test, desipramine, 20 mg.kg(-1), but not imipramine or sertraline, produced a significant increase in reaction time. In the formalin test, desipramine and imipramine produced significant reductions in the licking time at over 5 mg.kg(-1) and at over 10 mg.kg(-1), respectively. These reductions were nearly complete at 20 mg.kg(-1). On the other hand, both SSRIs induced significant reductions in the licking time only at 20 mg.kg(-1). Prazosin, WB-4101, and ketanserin significantly antagonized the antinociceptive effect of 10 mg.kg(-1) of imipramine. However, imipramine-induced antinociception was not affected by yohimbine and WAY-100635. Prazosin and ketanserin also significantly suppressed antinociception by 5 mg.kg(-1) of desipramine.

CONCLUSION

These findings suggest that classical TCAs are likely to have a therapeutic advantage over SSRIs for pain control. In addition, it is likely that central alpha(1) adrenoceptors and 5-HT(2) receptors are predominantly involved in imipramine- and desipramine-induced antinociception.

Dose-response relation and time course of action of pipecuronium in patients anesthetized with nitrous oxide and sevoflurane

The dose-response relation of pipecuronium, the time course of its neuromuscular blocking effects, and the reversibility of the residual block by neostigmine have been investigated in patients under sevoflurane/N2O Anesthesia using a neuromuscular transmission analyzer (Accelograph, Biometer, Denmark). After an initial dose of pipecuronium (0.04 mg.kg(-1), i.v.), the maximum block rate, onset time, the time from administration until 25% recovery and 50% recovery of control twitch height of the first response to train-of-four nerve stimulation and the interval time of administration of maintenance dose (0.005 mg.kg(-1), i.v.) were 93.7 +/- 7.68%, 5.0 +/- 1.84, 55.4 +/- 23.92, 73.0 +/- 29.44 and 38.7 +/- 15.50 minutes, respectively. The average intubation score (excellent; 0, good; 1 fair; 2, poor; 3) was 0.63 +/- 0.56 at the level of 95.88 +/- 5.06% block. Neostigmine (1.5 mg) promptly reversed the residual neuromuscular blockade induced by pipecuronium (reversal time: 10.1 +/- 2.98 minutes). No side effects attributable to pipecuronium was seen in this study. In conclusion, pipecuronium is a very useful nondepolarizing neuromuscular blocking agent especially for moderately long surgical procedure over 4-5 hours.

Physicians's reports on the impact of living wills at the end of life in Japan

CONTEXT

A growing number of Japanese people have completed advance directives, especially living wills, even though there is no legislation recognising such documents and little empirical research on their impact on clinical care at the end of life in Japan.

OBJECTIVES

To investigate physicians' attitudes about living wills and their experiences with patients who had completed a living will and later died.

DESIGN

Self administered survey and qualitative study using open question and content analysis.

SETTING

Japan.

PARTICIPANTS

Physicians known to have cared for a patient who had presented a living will prior to death.

MEASUREMENTS

The physician's response to receiving a living will, communication about the living will, the impact of the living will on clinical care, demographics, and their opinion on advance directives, especially living wills.

MAIN RESULTS

Fifty five per cent of respondents approved of advance directives in general, and 34% had more opportunities to communicate with a patient and his/her family after receiving the living will. Sixty nine per cent of the physicians who received a living will did not, however, change their course of therapy as a consequence of receiving the living wills. Based on the analysis, we identified three areas of concern in the comments on living wills: (1) concerns relative to patients, physicians, and families; (2) social context, and (3) clinical and administrative concerns. The physicians raised various topics for discussion; they tended to describe the issues from a clinical perspective.

CONCLUSIONS

Our identified areas of concern should prove helpful in better understanding the clinical and ethical implications of living wills in Japan.

Soft palate movement during sucking behavior

To clarify the aspects and role of oropharyngeal closure, soft palate movements during sucking were observed and then assessed by electromyographic and fluoroscopic analyses. Three patterns of sucking movements by the palatoglossus and levator veli palatini muscles were analyzed with electromyographic means in seven healthy adults. Furthermore, a forced sucking maneuver, which required special effort to produce a strong sucking pressure by opening the jaw, was analyzed using lateral fluoroscopy in three of the subjects. During all tested sucking movements, the palatoglossus muscle showed continuous activity. The levator veli palatini muscle did not show remarkable activity during regular air sucking or water sucking when water was held in the oral cavity. However, its participation increased when intraoral sucking pressure was increased by opening the jaw, and lateral fluoroscopic examinations revealed that the soft palate was pulled toward the oral cavity to form a tight contact between the rostral portion of the soft palate and the retrotongue, causing the soft palate to make an "L" shape. The palatoglossus muscle plays a major role in palatal movement during sucking. Furthermore, the levator veli palatini muscle, whose activity was observed only during high-pressure sucking with an open jaw, may act to maintain tension in the soft palate against strong negative pressure in the oral cavity.

Micropatterning of Ni particles on a BaTiO3 green sheet using a self-assembled monolayer

We studied surface modification of ceramic BaTiO(3) green sheets including polyvinylbutyral (PVB) as an organic binder and successfully fabricated a patterned self-assembled monolayer (SAM) which has a region of amino groups and a region of silanol groups on the green sheet. The patterned SAM was then immersed in water containing Ni particles that show negative zeta potential in water. Ni particles were attracted to the amino groups of the patterned SAM that show positive zeta potential by attractive electrostatic interaction. Consequently, a micropattern of Ni particles was achieved using a SAM at room temperature in water. This process can be used to fabricate a thin uniform internal Ni electrode for miniaturized high-performance multilayer ceramic capacitors (MLCC).

An involvement of trigeminal mesencephalic neurons in regulation of occlusal vertical dimension in the guinea pig

Although the occlusal vertical dimension (OVD) is strictly controlled, the neuronal mechanism of its regulation is still unclear. We hypothesize that neurons in the trigeminal mesencephalic nucleus (MesV) play an important role in the regulation of the OVD, because the MesV receives the projection from jaw-closing muscle spindles and periodontal mechanoreceptors. We measured the temporal OVD change in the guinea pig to study the effects of MesV lesions on the OVD. OVD-raised animals without MesV lesions showed a rapid OVD decrease to the same level as that in naïve controls, followed by an OVD increase after the OVD-raising appliance was removed. In contrast, OVD-raised animals with MesV lesions showed only a slight decrease in the OVD for 15 days after removal of the appliance, and then the OVD increased. The time-course of OVD development in normal-bite animals with MesV lesions was similar to that of naïve controls. These results suggest that MesV neurons are involved in OVD regulation.

Pea Tissue Necrosis Induced by Cucumber mosaic virus Alone or Together with Watermelon mosaic virus

Necrotic diseases of the stems, petioles, and leaves of pea plants (Pisum sativumL.), leading to wilting and death, occur in the Wakayama and Mie Prefectures of Japan. Based on host range, symptomatology, electron microscopy, and serological relationships, Watermelon mosaic virus (WMV) and three Cucumber mosaic virus (CMV) isolates (PE2, PE3A, and PB1) were isolated from diseased plants in the Wakayama Prefecture. In the Mie Prefecture, CMV (PEAN) also was isolated from pea plants with similar symptoms. Single infection with CMV (PB1 or PEAN) caused stem necrosis and eventual death of pea plants. Similar symptoms developed after double infection with WMV and PE2 or PE3A, whereas single infection with PE2 and PE3A induced symptomless infection in pea plants. We concluded either CMV alone or synergistic effects of mixed infection with CMV and WMV induced pea plant stem necrosis.