Simultaneous visualization of extrinsic and intrinsic axon collaterals in Golgi-like detail for mouse corticothalamic and corticocortical cells: a double viral infection method

Here we present a novel tracing technique to stain projection neurons in Golgi-like detail by double viral infection. We used retrograde lentiviral vectors and adeno-associated viral vectors (AAV) to drive “TET-ON/TET-OFF system” in neurons connecting two regions. Using this method, we successfully labeled the corticothalamic (CT) cells of the mouse somatosensory barrel field (S1BF) and motor cortex (M1) in their entirety. We also labeled contra- and ipsilaterally-projecting corticocortical (CC) cells of M1 by targeting contralateral M1 or ipsilateral S1 for retrograde infection. The strength of this method is that we can observe the morphology of specific projection neuron subtypes en masse. We found that the group of CT cells extends their dendrites and intrinsic axons extensively below but not within the thalamorecipient layer in both S1BF and M1, suggesting that the primary target of this cell type is not layer 4. We also found that both ipsi- and contralateral targeting CC cells in M1 commonly exhibit widespread collateral extensions to contralateral M1 (layers 1–6), bilateral S1 and S2 (layers 1, 5 and 6), perirhinal cortex (layers 1, 2/3, 5, and 6), striatum and claustrum. These findings not only strengthened the previous findings of single cell tracings but also extended them by enabling cross-area comparison of CT cells or comparison of CC cells of two different labeling.

Characterization of claustral neurons by comparative gene expression profiling and dye-injection analyses

The identity of the claustrum as a part of cerebral cortex, and in particular of the adjacent insular cortex, has been investigated by connectivity features and patterns of gene expression. In the present paper, we mapped the cortical and claustral expression of several cortical genes in rodent and macaque monkey brains (nurr1, latexin, cux2, and netrinG2) to further assess shared features between cortex and claustrum. In mice, these genes were densely expressed in the claustrum, but very sparsely in the cortex and not present in the striatum. To test whether the cortical vs. claustral cell types can be distinguished by co-expression of these genes, we performed a panel of double ISH in mouse and macaque brain. NetrinG2 and nurr1 genes were co-expressed across entire cortex and claustrum, but cux2 and nurr1 were co-expressed only in the insular cortex and claustrum. Latexin was expressed, in the macaque, only in the claustrum. The nurr1⁺ claustral neurons expressed VGluT1, a marker for cortical glutamatergic cells and send cortical projections. Taken together, our data suggest a partial commonality between claustral neurons and a subtype of cortical neurons in the monkey brain. Moreover, in the embryonic (E110) macaque brain, many nurr1⁺ neurons were scattered in the white matter between the claustrum and the insular cortex, possibly representing their migratory history. In a second set of experiments, we injected Lucifer Yellow intracellularly in mouse and rat slices to investigate whether dendrites of insular and claustral neurons can cross the border of the two brain regions. Dendrites of claustral neurons did not invade the overlying insular territory. In summary, gene expression profile of the claustrum is similar to that of the neocortex, in both rodent and macaque brains, but with modifications in density of expression and cellular co-localization of specific genes.

U-shape rotating anti-cathode compact X-ray generator: 20 times stronger than the commercially available X-ray source

A new type of U-shape anti-cathode X-ray generator in which the inner surface of a cylindrical target is irradiated by an electron beam has been made by modifying a conventional rotating anti-cathode X-ray generator whose brightness in the catalog is 12 kW mm(-2). The target material (Cu), target radius (50 mm) and rotating speed (6,000 r.p.m.) were not changed in this modification. A brightness of 52 kW mm(-2) was obtained by this U-shape-type X-ray generator. This means that the brightness of the new type is 4.3 times greater than that of the old unmodified one. Furthermore, the new-type X-ray generator yielded a brightness of 129 kW mm(-2) by adding a carbon coating on the Cu target. This means an overall increase of brightness of ten times. The original generator has the highest brightness in the generators of the same class (having a radius of 50 mm and rotation speed of 6,000 r.p.m.). Observations showed that Cu Kα counts at vertical incidence of the electron beam onto the surface of the new target, which is initially optically smooth, decrease as the surface is roughened by a severe thermal stress caused by strong electron beam exposure. Further observation reveals, however, that oblique incidence of the electron beam onto the roughened surface drastically increased the X-ray output and amounts to twice as much as that from a smooth surface at vertical incidence. Thus, at the present stage, an overall increase of brightness has been realised at a level 20 times stronger than that of the original commercially offered X-ray generator that we modified.

Streamline phenomena in liver metastasis of gastrointestinal tumors - a clinical-study based upon 172 patients

Location and number of liver metastasis of gastrointestinal tumors were detected preoperatively and intraoperatively. The distribution of the liver segment(s) occupied by metastatic tumors varied significantly (p<0.05). Significantly more frequent distributions were demonstrated in the lateral segment with gastric cancer (p<0.05), in the posterior segment with left colic cancer (p<0.001), in the medial segment with rectal cancer (p<0.01), in the anterior segment with bile duct cancer (p<0.05) and the whole of the liver with pancreatic cancer (p<0.05). Significantly less frequent distribution was demonstrated in the posterior segment with gastric cancer (p<0.01). When the liver was divided into the right and the left halves, the distribution of each half of the liver occupied by metastatic tumors varied significantly (p<0.05). Liver metastases of whole colic cancer were significantly more frequent in the right half of the liver (p<0.05). The results suggest that the tumor distribution in liver metastases of gastrointestinal tumors differ depending upon the primary tumors, basically in accordance with the 'streamline' phenomena.

Area-specific substratification of deep layer neurons in the rat cortex

Gene markers are useful tools to identify cell types for fine mapping of neuronal circuits. Here we report area-specific sublamina structure of the rat cerebral cortex using cholecystokinin (cck) and purkinje cell protein4 (pcp4) mRNAs as the markers for excitatory neuron subtypes in layers 5 and 6. We found a segregated expression, especially pronounced in layer 6, where corticothalamic and corticocortical projecting neurons reside. To examine the relationship between gene expression and projection target, we injected retrograde tracers into several thalamic subnuclei, ventral posterior (VP), posterior (PO), mediodorsal (MD), medial and lateral geniculate nuclei (MGN and LGN); as well as into two cortical areas (M1 and V1). This combination of tracer-in situ hybridization (ISH) experiments revealed that corticocortical neurons predominantly express cck and corticothalamic neurons predominantly express pcp4 mRNAs in all areas tested. In general, cck(+) and pcp4(+) cells occupied the upper and lower compartment of layer 6a, respectively. However, the sublaminar distribution and the relative abundance of cck(+) and pcp4(+) cells were quite distinctive across areas. For example, layer 6 of the prelimbic cortex was almost devoid of cck(+) neurons, and was occupied instead by corticothalamic pcp4(+) neurons. In the lateral areas, such as S2, there was an additional layer of cck(+) cells positioned below the pcp4(+) compartment. The claustrum, which has a tight relationship with the cortex, mostly consisted of cck(+)/pcp4(-) cells. In summary, the combination of gene markers and retrograde tracers revealed a distinct sublaminar organization, with conspicuous cross-area variation in the arrangement and relative density of corticothalamic connections.

Fluorescent in situ hybridization technique for cell type identification and characterization in the central nervous system

Central nervous system consists of a myriad of cell types. In particular, many subtypes of neuronal cells, which are interconnected with each other, form the basis of functional circuits. With the advent of genomic era, there have been systematic efforts to map gene expression profiles by in situ hybridization (ISH) and enhancer-trapping strategy. To make full use of such information, it is important to correlate "cell types" to gene expression. Toward this end, we have developed highly sensitive method of fluorescent dual-probe ISH, which is essential to distinguish two cell types expressing distinct marker genes. Importantly, we were able to combine ISH with retrograde tracing and antibody staining including BrdU staining that enables birthdating. These techniques should prove useful in identifying and characterizing the cell types of the neural tissues. In this article, we describe the methodology of these techniques, taking examples from our analyses of the mammalian cerebral cortex.

Analysis of area-specific expression patterns of RORbeta, ER81 and Nurr1 mRNAs in rat neocortex by double in situ hybridization and cortical box method

BACKGROUND

The mammalian neocortex is subdivided into many areas, each of which exhibits distinctive lamina architecture. To investigate such area differences in detail, we chose three genes for comparative analyses, namely, RORbeta, ER81 and Nurr1, mRNAs of which have been reported to be mainly expressed in layers 4, 5 and 6, respectively. To analyze their qualitative and quantitative coexpression profiles in the rat neocortex, we used double in situ hybridization (ISH) histochemistry and cortical box method which we previously developed to integrate the data of different staining and individuals in a standard three-dimensional space.

PRINCIPAL FINDINGS

Our new approach resulted in three main observations. First, the three genes showed unique area distribution patterns that are mostly complementary to one another. The patterns revealed by cortical box method matched well with the cytoarchitectonic areas defined by Nissl staining. Second, at single cell level, RORbeta and ER81 mRNAs were coexpressed in a subpopulation of layer 5 neurons, whereas Nurr1 and ER81 mRNAs were not colocalized. Third, principal component analysis showed that the order of hierarchical processing in the cortex correlates well with the expression profiles of these three genes. Based on this analysis, the dysgranular zone (DZ) in the somatosensory area was considered to exhibit a profile of a higher order area, which is consistent with previous proposal.

CONCLUSIONS/SIGNIFICANCE

The tight relationship between the expression of the three layer specific genes and functional areas were revealed, demonstrating the usefulness of cortical box method in the study on the cerebral cortex. In particular, it allowed us to perform statistical evaluation and pattern matching, which would become important in interpreting the ever-increasing data of gene expression in the cortex.

Caspase-mediated changes in histone H1 in early apoptosis: prolonged caspase activation in developing olfactory sensory neurons

Programmed cell death or apoptosis is required for the patterning and development of multicellular organisms. However, apoptosis is a difficult process to measure because the dead cells are rapidly degraded by their neighbors within a few hours. The post-caspase activation events that determine whether a cell will undergo apoptosis remain elusive. Here we report that apoptosis-specific nuclear events that occur before DNA fragmentation can be distinguished by monitoring the histone H1 status. In both mammals and Drosophila, dying cells failed to be immunolabeled with an anti-H1 monoclonal antibody, AE-4. Real-time imaging of caspase activation and H1 dynamics in mammalian neural cells revealed that H1 changed its location in the nucleus after caspase activation. In addition, the timing of this re-localization was largely dependent on the apoptotic stimulus used. From the staining patterns of AE-4 and anti-active caspase-3 antibodies, cells undergoing the transition from caspase activation to the apoptotic H1 change could be identified as H1-positive caspase-activated cells, providing a novel criterion for early apoptosis and making it possible to characterize caspase-activated cells in tissues. On the basis of these staining patterns, we found that many olfactory sensory neurons in the developing mouse olfactory epithelium showed sustained caspase activity without the H1 change, suggesting a unique caspase function in these neurons.

Highly bright X-ray generator using heat of fusion with a specially designed rotating anticathode

A new type of rotating anticathode X-ray generator has been developed, in which the electron beam irradiates the inner surface of a U-shaped anticathode (Cu). A high-flux electron beam is focused on the inner surface by optimizing the shape of the bending magnet. The power of the electron beam can be increased to the point at which the irradiated part of the inner surface is melted, because a strong centrifugal force fixes the melted part on the inner surface. When the irradiated part is melted, a large amount of energy is stored as the heat of fusion, resulting in emission of X-rays 4.3 times more brilliant than can be attained by a conventional rotating anticathode. Oscillating translation of the irradiated position on the inner surface during use is expected to be very advantageous for extending the target life. A carbon film coating on the inner surface is considered to suppress evaporation of the target metal and will be an important technique in further realization of highly bright X-ray generation.

Medical rehabilitation of the patients with spinal cord injury caused by aortic aneurysm and its operation

OBJECTIVES

To determine the natural course of spinal cord injury (SCI) after aortic aneurysm surgery.

SETTING

Acute care and semi-acute wards in Osaka Rosai Hospital, Japan.

METHODS

From 1998 to 2003, 12 patients with thoracic SCI (eight men and four women; mean age: 69 years) were enrolled and evaluated by the American Spinal Injury Association (ASIA) impairment scale and Functional Independence Measure (FIM), and the results were analyzed.

RESULTS

The level of SCI was distributed from T5 to L1. The ASIA impairment scale was A in four patients, B in four, C in three and D in one. Finally, six patients were discharged to home, and two patients died during hospitalization. Excluding the value of the deceased patients, the mean motor FIM was initially 32+/-15.6 (13-59) points and became 61+/-21.4 (29-88) points at discharge. Referencing the databases of SCI in Japan and USA revealed that the complication rates of pneumonia and aspiration were higher in our cases. The motor FIM before rehabilitation and at discharge were relatively lower than in the databases, but the gain and the rate of gain were similar to the Japanese database.

CONCLUSION

SCI associated with aortic aneurysm surgery was noticed especially in the elderly patients using airways (for example, tracheostomy). The higher age and recurrent nerve palsy were associated with deconditioning state to develop aspiration pneumonia. This state impaired the general condition, and such vicious cycle led to poor prognosis and functional outcome.

Binding and complementary expression patterns of semaphorin 3E and plexin D1 in the mature neocortices of mice and monkeys

Although axon guidance molecules play critical roles in neural circuit formation during development, their roles in the adult circuit are not well understood. In this study we examined the expression patterns of Semaphorin 3E (Sema3E), a member of the semaphorin family, in the mature neocortices of monkeys and mice by in situ hybridization (ISH). We found that Sema3E mRNA is highly specific to layer VI throughout the macaque monkey neocortex. We further examined the ratio of Sema3E+ cells among the layer VI excitatory neurons in areas M1, S1, TE, and V1 by fluorescence double ISH, using the vesicular glutamate transporter 1 (VGluT1) gene as a specific marker for excitatory neurons. Among these areas, 34-63% of the VGluT1+ neurons expressed Sema3E mRNA. In the mouse cortex, two significant differences were observed in the pattern of Sema3E mRNA distribution. 1) Sema3E mRNA was expressed in layer Vb, in addition to layer VI in mice. 2) A subset of GABAergic interneurons expressed Sema3E mRNA in mice. By an in vitro binding experiment, we provide evidence that Plexin D1 is the specific receptor for Sema3E. Plexin D1 mRNA was preferentially expressed in layers II-V in both monkey and mouse cortices. The detailed lamina analysis by double ISH, however, revealed that Plexin D1 mRNA is expressed in layers II-Va, but not in layer Vb in the mouse cortex. Thus, the Plexin D1 and Sema3E mRNAs exhibit conserved complementary lamina patterns in mice and monkeys, despite the species differences in the pattern of each gene.

Comparative analysis of layer-specific genes in Mammalian neocortex

We examined the expression patterns of 4 layer-specific genes in monkey and mouse cortices by fluorescence double in situ hybridization. Based on their coexpression profiles, we were able to distinguish several subpopulations of deep layer neurons. One group was characterized by the expression of ER81 and the lack of Nurr1 mRNAs and mainly localized to layer 5. In monkeys, this neuronal group was further subdivided by 5-HT2C receptor mRNA expression. The 5-HT2C(+)/ER81(+) neurons were located in layer 5B in most cortical areas, but they intruded layer 6 in the primary visual area (V1). Another group of neurons, in monkey layer 6, was characterized by Nurr1 mRNA expression and was further subdivided as Nurr1(+)/connective tissue growth factor (CTGF)(-) and Nurr1(+)/CTGF(+) neurons in layers 6A and 6B, respectively. The Nurr1(+)/CTGF(+) neurons coexpressed ER81 mRNA in monkeys but not in mice. On the basis of tracer injections in 3 monkeys, we found that the Nurr1(+) neurons in layer 6A send some corticocortical, but not corticopulvinar, projections. Although the Nurr1(+)/CTGF(-) neurons were restricted to lateral regions in the mouse cortex, they were present throughout the monkey cortex. Thus, an architectonic heterogeneity across areas and species was revealed for the neuronal subpopulations with distinct gene expression profiles.

A report of two cases treated with Pauwels' femoral osteotomy for advanced osteoarthritis resulting from a sequela of infectious coxitis in childhood

Pauwels' femoral valgus osteotomy was performed on two osteoarthritic hips that developed as a sequela of infectious coxitis in the childhood. One of the hips was diagnosed as osteomyelitis of the ipsilateral femur before the operation and was treated with curettage and implantation of antibiotic-impregnated cement beads. The results of both hips were excellent and maintained for 9-11 years.

Measurement of positron production efficiency from a tungsten monocrystalline target using 4- and 8-GeV electrons

Intense positron sources are being widely investigated for the next-generation linear colliders and B factories. A new method utilizing an axially oriented crystal as a positron-production target is one of the bright schemes, since it provides a powerful photon source through channeling and coherent bremsstrahlung processes when high-energy electrons penetrate the target. A series of positron-production experiments with tungsten crystals hit by 4- and 8-GeV single-bunch electron beams were carried out at the KEKB 8-GeV injector linac. Three tungsten crystals with different thicknesses (2.2, 5.3, and 9.0 mm) and those combined with amorphous tungsten plates were tested on a precise goniometer. The positron-production yields were measured with a magnetic spectrometer in the positron momentum (P(e(+))) range from 5 to 20 MeV/c. The angle of the <111> crystal axis with respect to the electron-beam direction was controlled by measuring the relative intensities of the produced positrons as a function of the rotational angle of the goniometer. The results show that the enhancements of the positron yield from crystal targets compared to amorphous targets of the same thickness at P(e(+))=20 MeV/c are from 1.5 to 3.7 and from 1.8 to 5.1, depending upon the target thickness for 4- and 8-GeV electrons, respectively.

[Valvular heart surgery in osteogenesis imperfecta]

Osteogenesis imperfecta is a disease in which fragile bones readily cause fracture. Valvular disease concurrently develops. However, the surgery-related mortality rate is approximately 30%. In this study, we report 2 patients with osteogenesis imperfecta who underwent valvular heart surgery. Patient 1 was a 31-year-old male. He had previously been diagnosed as having osteogenesis imperfecta. Echocardiography suggested aortic valve insufficiency, and aortic valve replacement was performed. Patient 2 was a 59-year-old male. During admission, osteogenesis imperfecta was diagnosed. Echocardiography suggested mitral valve insufficiency, and mitral valve plasty was performed. In the 2 patients, intraoperative hemorrhage was marked. However, there were no fatal complications. We also reviewed the literature.

Lower lip-lifting brace for bilateral facial nerve palsy: a case report

A 55-year-old man suffered from pontine hemorrhage 5 years before he visited our outpatient clinic with complaints of gait disturbance and dysphagia. At the first examination, his inability to close his mouth, eyes, and lower lip led to the diagnosis of facial diplegia. He was instructed to wear a gauze surgical mask and to use artificial saliva for his xerostomia. A videofluorogram of his swallowing excluded aspiration but revealed dysphagia attributable to neck hyperextension arising from efforts to prevent food spilling from his mouth. We prescribed a brace to lift his lower lip as a treatment of his dysphagia. This brace covered his chin to support his lower lip. Our brace resulted in improved function; liquids no longer leaked from his mouth and because the lip elevation eliminated his xerostomia, he no longer required artificial saliva or the gauze mask.

Lower limb amputation for diabetic foot

We amputated 35 limbs of 27 patients with diabetic foot from March 1988 to March 1998. The mean age of the patients at the time of operation was 67 years, and the mean follow-up period was 27 months. Thirteen patients died in the period from 1 day to 39 months after the operation. All patients suffering from diabetic foot were referred to our department for surgical procedures after failure of conservative treatment conducted elsewhere. Their feet were classified into grade 2-3 in 18 limbs, grade 4-5 in 11 limbs, and gangrene of the lower leg and entire foot in 2 limbs, as classified by the Wagner system. Two patients had cellulitis of the foot and two other limbs had infectious gonarthritis. All patients had type 2 diabetes with poor blood sugar control, and 90% were treated by insulin. All patients suffered from diabetic neuropathy. Half of the patients were put on hemodialysis because of diabetic nephropathy. More than 60% of the patients suffered from arteriosclerosis obliterans. The amputation level of the limb was determined by skin thermography, but the patient's will was critical. The initial amputation levels were: débridement and synovectomy in 4 limbs, toe and digital ray in 15 limbs, transmetatarsal in 3 limbs, transtibial in 9 limbs, transfemoral amputations in 4 limbs. Upper level reamputation was conducted on 15 limbs. Logistic regression analysis revealed that lower temperature of the amputation site, being female, and being elderly were significant risk factors in reamputation. Skin thermography was one of the effective determinants of amputation level, in order to avoid reamputation.

Aortic valve repair in dominant aortic regurgitation

OBJECTIVE

We studied immediate and mid-term results after aortic valve repair.

METHODS

Immediate and mid-term results were studied in 63 patients undergoing aortic valve repair, calculating survival and reoperation free rates.

RESULTS

Subjects were 49 men and 14 women aged 15 to 76 years (mean: 53 +/- 17 years). Mean preoperative aortic regurgitation grading of 1 to 4 was 3.2 +/- 0.7. Mean preoperative New York Heart Association functional class was 1.9 +/- 0.8. Two in-hospital deaths occurred. (3.2%) Mean aortic regurgitation grade at discharge was 1.3 +/- 0.8 (p < 0.0001; vs preoperative grade) and functional class was 1.1 +/- 0.2 (p < 0.0001; vs preoperative class),--significantly improved. Overall follow-up was 98.4%, and mean follow-up continued 41.4 +/- 22.1 months. Mean functional class at follow-up was 1.2 +/- 0.4 (n = 49), improved from preoperative class (p < 0.0001). Mean aortic regurgitation grading at follow-up was 1.8 +/- 0.8 (n = 41), improved from preoperative grading (p < 0.0001). Five-year survival was 95.1 +/- 2.8%. One-year reoperation freedom was 96.6 +/- 2.4% and 5-year 77.9 +/- 6.9%.

CONCLUSIONS

Survival after surgery was good, while reoperation was comparable to other reports but less satisfactory compared to reoperation freedom after aortic valve replacement. Based on reoperative findings, a change in indication was made. We believe technical refinements could improve postoperative results.

Midline retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysm repair

PURPOSE

The purpose of this study was to compare the midline retroperitoneal approach with the midline transperitoneal approach for abdominal aortic aneurysm (AAA) repair with respect to operative details, gastrointestinal complications, and wound complications.

METHODS

From January 1990 through January 1998, 128 patients underwent elective aortic reconstruction for infrarenal AAA. Of these, 64 patients (the transperitoneal group) underwent conventional transperitoneal midline aortic exposure, whereas the remaining 64 patients (the retroperitoneal group) underwent retroperitoneal midline exposure of the aneurysm.

RESULTS

Preclamp time, that is, the time from skin incision to aortic clamping, was significantly shorter in the transperitoneal group than in the retroperitoneal group (P <.001). However, the midline retroperitoneal approach was associated with decreased incidence of ileus (P <.01), earlier resumption of oral intake (P <.01), and decreased wound pain (P <.01), in comparison with the transperitoneal approach. Furthermore, there was no incidence of wound complications such as abdominal bulge or wound pain in any of the patients in the postoperative period or over the long term.

CONCLUSIONS

The midline retroperitoneal approach for AAA was associated with fewer postoperative gastrointestinal and wound complications than the midline transperitoneal approach. Over the long term, there was no wound complication such as abdominal bulge and wound pain in any of the patients.

The release of nitroglycerin absorbed into the central venous catheter

This study was conducted to evaluate the release of nitroglycerin (NG) that has been absorbed into the central venous catheter. A 0.05% NG solution was infused through a central venous catheter and the flow rates were set at 1, 5, or 10 ml/h, given over 12, 24, or 48 h. The catheter was flushed with lactate Ringer solution after completion of the NG infusion. The elution of the lactate Ringer solution from the tip of the catheter was then collected and assayed for its NG concentration by high performance liquid chromatography (HPLC). A higher concentration of NG was released with a faster flow rate and a longer infusion. The high level of NG release continued during the first 20 min, and ranged from a minimum of 0.07 mg/ml to a maximum that exceeded 0.15 mg/ml. Subsequently, the NG concentration gradually declined, but low concentrations of 0.006-0.02 mg/ml were still maintained 360 min later. Thus, it is suggested that if a catheter such as the Swan-Ganz continues to be used after the completion of a NG infusion, certain pharmacological effects due to the absorption of NG into the catheter body should be expected for at least 60 min.

Factors influencing joint-preserving operations in the treatment of the late stages of osteoarthritis of the hip

Between November 1983 and December 1992, 136 hips (119 patients) with coxarthritis were operated on using joint-preserving techniques based on the rationale of Pauwels’ osteotomy. The criterion for selection was a patient in whom the height of the joint space in the weight-bearing area of the hip was less than 1 mm. The mean age at operation was 48 years and the mean follow-up 109 months (60 to 171). Hips were categorised using Bombelli’s classification of osteoarthritis, into atrophic and non-atrophic types. The endpoint was defined as that at which the height of the joint space became less than 1 mm again. The Kaplan-Meier curve showed that the rate of survival of the non-atrophic group was significantly better than that of the atrophic group. Cox’s proportional hazard model indicated that the factors influencing the results of joint-preserving operations included Bombelli’s classification, postoperative incongruence of the joint and the height of the joint space.

Factors influencing joint-preserving operations in the treatment of the late stages of osteoarthritis of the hip

Between November 1983 and December 1992, 136 hips (119 patients) with coxarthritis were operated on using joint-preserving techniques based on the rationale of Pauwels' osteotomy. The criterion for selection was a patient in whom the height of the joint space in the weight-bearing area of the hip was less than 1 mm. The mean age at operation was 48 years and the mean follow-up 109 months (60 to 171). Hips were categorised using Bombelli's classification of osteoarthritis, into atrophic and non-atrophic types. The endpoint was defined as that at which the height of the joint space became less than 1 mm again. The Kaplan-Meier curve showed that the rate of survival of the non-atrophic group was significantly better than that of the atrophic group. Cox's proportional hazard model indicated that the factors influencing the results of joint-preserving operations included Bombelli's classification, postoperative incongruence of the joint and the height of the joint space.

Detection of hepatocellular carcinoma and its metastases with various pulse sequences using superparamagnetic iron oxide (SHU-555-A)

BACKGROUND

To identify the most useful combinations of various pre- and postcontrast magnetic resonance (MR) image sequences in detecting hepatocellular carcinoma (HCC) and its intrahepatic metastases before and after injection of SHU-555-A.

METHODS

Thirty-eight lesions in 16 patients were evaluated before and after administration of SHU-555-A by using fast spin echo (FSE), gradient echo (GRE), and echo planar (EP) imaging sequences using a 1.5-Tesla superconducting MR system. The signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) of the lesions, signal-to-noise ratios, and other parameters were calculated.

RESULTS

Tumors were better detected after injection of SHU-555-A on all pulse sequences except on out-of-phase T1-weighted (T1W)-GRE sequences. Tumor detectability was higher for precontrast EP imaging and T2*-weighted (T2*W)-GRE sequences, whereas detectability at postcontrast was higher for T2*W-GRE, proton-density-weighted-FSE, and in-phase T1W-GRE sequences. The SIR and CNR at precontrast were highest for EP imaging, and those at postcontrast were highest for T2*W-GRE.

CONCLUSION

SHU-555-A will increase the detectability of HCC and its liver metastases. T1W- and T2*W-GRE sequences would be the sequences of choice.

Postoperative renal function after an abdominal aortic aneurysm repair requiring a suprarenal aortic cross-clamp

We describe herein the postoperative renal functions of patients who required a suprarenal aortic cross-clamp during abdominal aortic surgery. Seven patients required a unilateral suprarenal aortic cross-clamp (group A) and six patients required a bilateral suprarenal clamp (group B). Eighty-three patients who required an infrarenal aortic clamp were assigned to group C. Renal hypothermia with renal perfusion or topical cooling during suprarenal clamp was not performed. No hospital deaths were encountered. In group B, the postoperative creatinine and blood urea nitrogen (BUN) levels remained statistically significantly higher than that of group C until the seventh postoperative day. The postoperative renal dysfunction (serum creatinine level >2.0 mg/dl) was 28.6% in group A and 50% in group B, while it was only 8.4% in group C, although no patient required either temporary or permanent hemodialysis. The postoperative peak BUN over 30 min suprarenal clamp was significantly higher than that within 30 min. In summary, the postoperative renal function was impaired after an extended bilateral suprarenal clamp. These findings suggest that if prolonged renal ischemia is thus expected, then renal preservation should be considered.

High-Fat diet enhances accumulation of hexachlorobenzene in rat dams and delays its transfer from rat dams to suckling pups through milk

Effect of diets on the distribution and transfer of hexachlorobenzene (HCB) from dams to fetuses and suckling pups was investigated. In pregnant rats, the amount of HCB accumulated in fat tissues of the high-fat diet group was higher than that of the control diet group (P < 0.05). The amounts of HCB in fetuses of the high-fat and control diet groups were estimated to be about 0.28 and 0.12% of the dam's total intake during pregnancy, respectively. In both groups, a large proportion of HCB in dams disappeared during lactation period and was transferred to their pups through the milk. In the pups of the high-fat diet group, the amount of HCB in stomach contents was lower immediately after birth and decreased slowly compared with that in the control diet group during lactation. These results showed that a high-fat diet reduced the speed of the transfer of HCB from the dams to their suckling pups through milk.

Dynamic MR imaging of the carotid wall

The purpose of this study was to clarify temporal changes of carotid wall enhancement using dynamic magnetic resonance (MR) and to correlate its findings with pathological conditions. Cervical carotid arteries of 84 consecutive patients were studied with a 1.5 T MR imager using phased array coils. Axial spoiled gradient-echo (SPGR) images (30-58 second scan time) with fat saturation were repeated 4-8 times after the injection of contrast material. We evaluated the presence and thickness of hypointense inner rims and hyperintense outer rims of the carotid wall, temporal changes of outer rim enhancement, and their changes in relation to pathological conditions. Hypointense inner rims and enhanced outer rims were clearly visualized in 87% (73/84) of our subjects. Enhancement of the outer rim was minimal in early phases and gradually increased. Patient age had a significant correlation with outer rim thickness. In the portions with large atheromatous plaques, inner rims were disrupted or thickened. A marked thickening of the outer rim was observed in one patient with arteritis. The outer rims adjacent to malignant tumors were often obscured. Our study suggests that dynamic MR images of the cervical carotid artery can uniquely demonstrate angiogenesis of the wall itself. The outer rim of the artery shows relatively rapid enhancement, and its thickness correlates with age.

Evaluation of effect and distribution of heparin administered in vascular reconstructive surgery

BACKGROUND

The aim of this study was to find out whether intravenously administered heparin is distributed equally not only proximal but also distal to the arterial occlusion level in vascular reconstructive surgery.

METHODS

Ten consecutive patients (7 men and 3 women) with an average age of 69.9 years (range, 51 to 76 years) who underwent graft replacement for aortic abdominal aneurysm from April to December 1994 were studied. Mean aortic clamp time was 76 minutes. Heparin sodium (100 U/kg) was administered intravenously to keep activated clotting time (ACT) over 250 secs and was neutralized by protamine sulfate (1 mg/kg) just after reperfusion. ACT, blood lactate and CPK-MM in the brachial and dorsal pedis artery were measured before heparin administration (control), just after arterial occlusion, just before reperfusion and 10 minutes after protamine administration.

RESULTS

ACT was significantly prolonged after arterial occlusion and recovered after protamine administration with no significant differences between proximal and distal values at each point. Lactate showed significant increase after arterial occlusion which was more remarkable distally. CPK-MM was all the way within the normal range.

CONCLUSIONS

In vascular reconstructive surgery which requires temporary arterial occlusion for as long as 80 minutes, the effect of heparin is excellent and equal throughout the body by collateral vessels, and the metabolic influence due to blockade of the blood flow is not so critical as to lead to cellular damage although anaerobic glycolysis is promoted distally due to hypoxia.

Validation of a microwave sterilizer for injection ampules

A program for validating the microwave sterilizer, which is a new type of sterilizer, was established and implemented. This program includes the following tests specific to microwave sterilizers: the internal pressure strength of ampules, the acceptable range of sterilizing temperature, performance and calibration of the infrared thermometer and the plane blackbody, maintaining of sterilizing temperature, the processing speed (sterilizing time), the unacceptable ampules selection mechanism, microwave leaks, and a microbiological challenge test of the ampule head space using a biological indicator. Injectable preparations of mecobalamin and diprophylline were used as models for validation of the microwave sterilizer. The bioburden approach was used for injectable mecobalamin preparation, and the over-kill approach was used for injectable diprophylline preparation. The basis for practical use of this microwave sterilizer has been confirmed by the establishment and implementation of this validation program.

Cardiopulmonary bypass established via a sutured vascular graft in the presence of extraanatomic bypass

Cardiopulmonary bypass (CPB) was established via a sutured collagen sealed knitted Dacron graft in two patients who had undergone extraanatomic bypasses for lower limb ischemia, whose ascending aorta was not suitable for cannulation. One patient, with a history of femorofemoral bypass, underwent surgery for a ruptured aortic arch aneurysm (AAA) and the other patient, with a history of axillobifemoral bypass for chronic dissection involving the aortic arch and descending aorta, had unstable angina and underwent coronary artery bypass grafting. This technique of perfusion was found to be safe and effective for patients with an impaired ascending aorta who have undergone an extraanatomic bypass for the lower limb.

Middle-term results of anatomic medullary locking total hip arthroplasty

We report the results of cementless, anatomic, medullary locking hip prosthesis application in our first consecutive series. We used the so-called Asian size of prosthesis with proportionally smaller stem sizes in both diameter and length. Forty-seven stems and sockets were analyzed with a mean follow-up of 69 months. The mean Merle d'Aubigné hip scores were 8 points preoperatively and 16 points at the final follow-up. Radiologically, the stems showed excellent stability without loosening. Stress shielding around the stems did occur in most cases but did not progress. Preoperative bone quality influenced the extent of stress shielding evaluated at the final follow-up: higher stress shielding was noted in poorer quality bones at the time of operation. There were problems with the sockets. The shallow socket and impingement at the protruded rim seemed to cause a high incidence of dislocation (13%). Massive polyethylene wear occurred in 5 sockets. These sockets were 48 and 46 mm in diameter with 26 mm heads. In conclusion, the stems of the anatomic medullary locking hip prostheses used in Japan showed satisfactory stability even in poor quality bones, but there were problems with the polyethylene liners. Our solution was to use larger sockets with 22 mm heads.

[The perspective of a medical technologist]

Medical technologists must send reliable laboratory data to clinicians before consulting about the data. It is indispensable for medical technologists to acquire and maintain special technological knowledge. What technologists can do to support clinical work is derived basically from the information involved in analyzing samples. Such information could be sent along with the data to the clinical doctor and thus support clinical work. In large hospitals, such as university hospitals, in addition to the usual support for clinicians, we should attempt to develop new methods for analyzing pathological conditions in various diseases. Moreover, we could even support clinical research with our special technological knowledge and skilled application. However, in small hospitals, medical technologists may have to do work that doctors in the laboratory usually do. Curricula and textbooks must be prepared to educate technologists to assume those roles when necessary.

Massive aortic regurgitation by spontaneous rupture of a fibrous strand in a fenestrated aortic valve

A very rare case of Marfan syndrome associated with acute aortic regurgitation due to rupture of a fibrous strand of a fenestrated aortic valve is presented. Although an aortic valve fenestration usually has no pathologic significance, its association with aortic annular dilatation plays an important role. Rupture of a myxomatously degenerated fibrous strand loaded with high tension from annular dilatation reducing the coaptation area of each cusp during diastole was the suspected cause of acute massive regurgitation by complete retroversion of the right coronary cusp. Rupture of a fibrous strand of a fenestrated aortic valve with a dilated annulus could result in acute massive aortic regurgitation, for which prompt surgical repair is mandatory.

Primary aortoenteric fistula with a chronic isolated abdominal aortic dissection: report of a case

A 47-year-old woman on long-term hemodialysis due to a chronic isolated abdominal aortic dissection was admitted to our department with severe abdominal pain. She had not suffered any hematemesis or melena. An emergency laparotomy revealed an abdominal aortic aneurysm with a diameter of 60mm, densely adhered to the ileum. An aortoenteric fistula manifesting as intramural rupture into the ileum was found after infrarenal abdominal aortic and bilateral common iliac cross-clamping. The fistula on the ileac side was nontransmural, but that on the aortic side communicated with the pseudolumen of the abdominal aorta, and contained mural thrombus. The infrarenal abdominal aorta and bilateral common iliac arteries were replaced with a collagen-sealed woven Dacron bifurcated graft. Histological examination of the ileum in this portion showed intramural bleeding and xanthomatous granulation with foam cell infiltration in the thickened subserosa. While it is difficult to diagnose nonpenetrating aortoenteric fistula preoperatively, such a fistula must be considered in a patient with severe abdominal pain, for whom previous abdominal aortic surgery has been performed or when an abdominal aneurysm is observed. To our knowledge, no other case of an aortoenteric fistula presenting as an intramural rupture into the ileum in an isolated abdominal aortic dissection has ever been reported.

Heel lifting as a conservative therapy for osteoarthritis of the hip: based on the rationale of Pauwels' intertrochanteric osteotomy

Patients with osteoarthritis of the hip were treated with a conservative therapy of heel lifting. Orthoses were applied on 35 hips in 33 subjects and the cases were followed for 23 months on average. Dramatic pain relief was reported, but the time required to reduce or completely relieve pain increased according to the stage of osteoarthritis. The radiological results were not satisfactory. During the follow-up, only two hips showed improvement, 22 showed no change, and 11 deteriorated. The mechanism of heel lifting in relation to the hip joint was analysed, showing that pelvic obliquity was achieved and the trunk stabilized. In conclusion this simple orthosis was effective as a palliative therapy for osteoarthritis of the hip.

[The leaflet fracture of a 19 mm SJM (HP) valve during valve insertion to the calcified small aortic annulus]

Aortic valve replacement was undergone in a 70-year-old woman with calcified aortic stenosis. Calcified and fused tricuspid aortic valve was excised and a 21 mm sizer passed with some difficulty through the annulus. A 19 mm SJM HP serious was selected and the horizontal mattress suturing technique was used. The valve was held at the cuff near the hinge guard and seated into the annulus by the usual amount of pressure, however, one leaflet fracture was retrieved and the valve was removed. A 19 mm standard SJM valve was then successfully implanted. The potential factors of leaflet fracture suggested that the leaflet thickness of smaller sized SJM valves showed smaller values than other bileaflet valves in the same sized-valves. In addition, the SJM valve does not have an orifice stiffening ring like other bileaflet valves. So, needless to say direct pressure to the leaflet, indirect pressure might cause valve destruction during insertion. The abnormal pressure applied to the direction from one hinge guard to the other can introduce deforming of the orifice ring resulting in leaflet fracture like this case. The pressure directed to the perpendicular direction may introduce leaflet escape due to the deforming of the valve orifice.

Hexachlorobenzene accumulated by dams during pregnancy is transferred to suckling rats during early lactation

The distribution of ingested stable, lipophilic environmental pollutants in dams and their transfer to fetuses and sucklings were investigated in rats fed a diet containing a small amount (35.1 nmol/100 g diet) of hexachlorobenzene (HCB). In the first experiment, we examined the distribution of HCB in pregnant and nursing rats fed the HCB diet during pregnancy and lactation. Its transfer to their sucklings was also studied. On d 16 after parturition, HCB concentrations in the blood, and subcutaneous and perirenal fat of nursing rats fed the HCB diet during pregnancy and lactation were approximately 1/3.5, 1/15 and 1/2.8, respectively, those of pregnant rats fed the HCB diet only during pregnancy. On the other hand, the HCB concentrations in the blood, and subcutaneous and perirenal fat of sucklings were approximately 6, 29 and 15 times higher than those of their dams. Therefore, a large amount of HCB apparently was transferred from dams to suckling pups through the milk. In the second experiment, we fed dams the HCB diet only during pregnancy and determined the distribution of HCB in the pregnant rats and fetuses as well as in the nursing rats and suckling pups. The estimated amount of HCB transferred from a dam to her fetuses corresponded to about 0.39% of her total intake during pregnancy. The amount of HCB detected in nursing rats on d 16 after parturition was much smaller than that in the pregnant rats, suggesting that a large proportion of the HCB that accumulated during pregnancy disappeared from the organs and fat tissues during lactation. The HCB concentration in the stomach contents of suckling pups fed by the dams who had consumed HCB before parturition was highest on d 2 after birth and decreased gradually during the 16 d after birth. In the blood, liver and fat tissues of suckling rats, the HCB concentrations increased until 7 d after birth and then decreased gradually. We conclude that the HCB that accumulated in dams during pregnancy was transferred to their suckling pups through milk in the early days after birth.

Induction of apoptosis in various tumor cell lines by geranylgeraniol

We have found that GGO is a potent inducer of apoptosis in various human tumor cell lines, including a myeloid multipotential leukemia K562 cell line which is resistant to the induction of apoptosis by various apoptosis-inducing agents and conditions. Polyprenylalcohols with isoprenyl units shorter than the geranylgeranyl group or longer than farnesyl group were less effective in inducing apoptosis in myeloid leukemia HL-60 cells and polyprenylketones had no apoptosis-inducing activity. The fragmentation of DNA in HL-60 cells by GGO was so rapid, no significant effect on the cell cycle was observed. [3H]GGO was taken up by HL-60 cells in 3 h and was incorporated into several proteins. The expression of c-myc and bcl-2 decreased significantly within 3 h of the start of the treatment of HL-60 cells with 50 microM GGO.

Thrombotic obstruction of a reinforced ringed expanded polytetrafluoroethylene graft caused by formation of a pseudoaneurysm at a nonanastomotic site: report of a case

We report herein the case of a 72-year-old man in whom a nonanastomotic pseudoaneurysm arose from a reinforced ringed expanded polytetrafluoroethylene (EPTFE) graft (Gore-Tex, Flagstaff, AZ, USA) following an axillobifemoral bypass. The pseudoaneurysm developed 2 years after graft insertion and induced graft thrombosis. The development of the pseudoaneurysm can be attributed to the fact that his axillobifemoral bypass graft was so short it deformed the proximal anastomosis, and the graft was subcutaneously tunneled onto the major pectoral muscle. These technical errors placed the graft under too much tension in the longitudinal direction, which resulted in graft disruption and pseudoaneurysmal formation, followed by thrombosis of the axillary artery. Moreover, the possibility of direct trauma at the time of insertion cannot be substantiated. Although the very poor compliance and design of the externally supported ring could not tolerate stretch deformity in the Gore-Tex graft, only one other case of a nonanastomotic pseudoaneurysm has ever been reported.

Geranylgeraniol causes a decrease in levels of calreticulin and tyrosine phosphorylation of a 36-kDa protein prior to the appearance of apoptotic features in HL-60 cells

It was demonstrated recently that geranylgeraniol (GGO) has potent apoptosis-inducing activity in various lines of tumor cells, including HL-60 cells. In the present study, we found that GGO markedly inhibited the expression of a calcium-binding protein, calreticulin, prior to the induction of apoptosis in HL-60 cells. Furthermore, we also observed a significant decrease in the tyrosine phosphorylation of a 36-kDa protein that is a major tyrosine-phosphorylated protein in HL-60 cells. These findings suggest that decreases in levels of calreticulin and in the tyrosine phosphorylation of the 36-kDa protein might be associated with the induction of apoptosis by GGO in HL-60 cells.

Effect of boiled barley-rice-feeding in hypercholesterolemic and normolipemic subjects

Barley contains approximately 10% dietary fiber and is easily cooked with rice, the dominant cereal in Japan, to increase the intake of dietary fiber. This research involved three experiments to examine the influence of barley on blood lipids in human subjects. All subjects received a boiled barley-rice (50/50 w/w mix) supplement two times per day in place of rice for 2 or 4 weeks. In the normolipemic subjects, serum lipids were unaffected by the ingestion of barley for 4 weeks. In twenty hypercholesterolemic men aged 41 +/- 5 years, the ingestion of barley was associated with a significant fall in serum total cholesterol, LDL-cholesterol, phospholipids and LDL and VLDL-lipoproteins. In seven mildly hypercholesterolemic women aged 56 +/- 7 years, a significant improvement of serum lipid profiles was observed. The present study suggests the possibility that the ingestion of barley-rice could lower serum lipids in hypercholesterolemic subjects.

Geranylgeraniol is a potent inducer of apoptosis in tumor cells

We screened various isoprenoids to find inducers of apoptosis for human leukemia HL-60 cells, and found that GGO (geranylgeraniol) had the most potent apoptosis-inducing activity, as judged from DNA fragmentation in HL-60 cells. The apoptosis-inducing activity of GGO is concentration- and time-dependent. DNA synthesis by HL-60 cells was selectively inhibited on treatment with GGO. Besides HL-60 cells, apoptosis was induced by GGO in various tumor cell lines, including human myeloid multipotential leukemia K562, lymphoblastic leukemia Molt3, and colon adenocarcinoma COLO320 DM.

Novel role of vitamin K2: a potent inducer of differentiation of various human myeloid leukemia cell lines

When myeloblastic ML1 cells were cultured in the presence of Vitamin K2 (menaquinone, VK2), the population of cells capable of reducing NBT increased to 83.5% at low VK2 concentration of 1 microM, indicating VK2 induces cellular differentiation. VK2 also exerted differentiation-inducing action on histiocytic U937 and promyelocytic HL60 cell lines. None of these effects were observed with Vitamin K1 (phylloquinone, VK1), suggesting the geranylgeranyl group of the side chain of VK2 to be essential to these effects. Combinations of VK2 with other differentiation-inducers such as interferon-gamma, retinoic acid, or camptothecin additively or synergistically induced the differentiation of HL-60 cells. These results suggest that VK2 may safely be used in differentiation therapy in combination with other inducers.