Peripheral non-small cell lung cancers 2.0 cm or less in diameter: proposed criteria for limited pulmonary resection based upon clinicopathological presentation

Clinical features of peripheral non-small cell lung cancer 2.0 cm or less were retrospectively analyzed. Nodal status and prognosis in relation to tumor diameter and histologic type were investigated in 171 consecutive patients with peripheral clinical T1N0M0 non-small cell lung carcinomas 2 cm or less in diameter and who had undergone surgical resection between 1976 and 1997. Of the 171 patients, 136 had adenocarcinoma, 27 had squamous cell carcinoma, four had large cell carcinoma, three had carcinoid and one had adeno-squamous carcinoma. There was no statistically significant difference in the incidence of stage I cases between adenocarcinoma and squamous cell carcinoma. Lymph node involvement was recognized in 30 (17.5%) patients: ten (5.8%) at N1 nodes and 20 (11.7%) at N2 nodes. Lymph node metastasis was significantly more common in tumors 1.5-2.0 cm in diameter (22%) than in those 1.5 cm or less in diameter (14.0%, P = 0.0490). There was no lymph node metastasis in tumors 1.0 cm or less in diameter. The 5-year survival rates cases with or without lymph node involvement were 63.3 and 75.3%, respectively, showing significant difference (P = 0.0338). The result of the present study suggested that systematic mediastinal and hilar lymph node dissection is necessary even for cases with tumor diameter less than 2 cm. However, if the tumor is within 1.0 cm in diameter, mediastinal lymph node dissection might be dispensable; therefore, these cases are good candidates for video-assisted lobectomy.

Surface roughness of cellulose hollow fiber dialysis membranes and platelet adhesion

A great deal of research has been conducted focusing on membrane materials with reference to their blood compatibility, but blood compatibility is influenced both by the material used in membranes and their structure, and by the flow conditions at the membrane surface. Accordingly, the relationship between membrane surface roughness and hemocompatibility has been evaluated using five types of membranes of differing surface roughness by evaluating the inner surfaces of the hollow fibers by atomic force microscopy (AFM) and by measuring platelet adhesion ratios using bovine blood. The yield stress, which equates to flow characteristics, was also evaluated using a glycerol suspension of polymethylmethacrylate (PMMA), a Bingham fluid. It was found that membranes having rough surfaces had high platelet adhesion ratios and poor hemocompatibility, whereas those with smoother surfaces had lower platelet adhesion ratios and better hemocompatibility. Measurement of the yield stresses for these membranes revealed higher values for those with rough surfaces, and lower values for those with smoother polyethylene glycol (PEG) grafted surfaces. This suggests that flow conditions at the membrane surface differ according to its surface roughness, and that this difference in flow conditions also influences hemocompatibility.

Recommendation of early surgery from the viewpoint of daily quality of life

We surveyed pre- and postoperative levels of satisfaction with a range of the daily quality-of-life (QOL) domains in 132 sets of epilepsy surgery patients and their families. All patients underwent resective surgery for temporal lobe epilepsy and were monitored for > 2 years. Patient and family assessments showed patients' overall QOL markedly improves after surgery, depending on freedom from seizures. However, factors such as social contacts, family relations, or financial status improved little. Some families and patients were not satisfied with the postsurgical status, despite freedom from seizures. Patients who had surgery at a later age were not so satisfied with their postsurgical status as were patients who had surgery at a younger age, particularly on the QOL domains of role activities, memory function, leisure activities, or emotional well-being. This lower satisfaction level in older patients likely results from a variety of problems affecting patients during the long-lasting epileptic process; social handicaps, psychologic conflicts, and deterioration of cognitive/behavioral functions. Based on each case, we recommend that investigations start at an early stage of the illness, so that surgical intervention may be considered as early as possible.

Midline thalamic lesion and feline amygdaloid kindling. I. Effect of lesion placement prior to kindling

Nine cats with electrolytic lesion in the massa intermedia (MI, N = 8) and ipsilateral nucleus centrum medianum (CM, N = 1) underwent primary and secondary site amygdaloid (AM) kindling and primary site retest. During primary site kindling, MI- but not CM-lesioned animals showed a pattern of seizure development strikingly similar to that of forebrain-bisected cats and the development of contralateral hemiconvulsive seizure was coincident with the onset of afterdischarge (AD) in the ipsilateral motor cortex. Unlike the forebrain-bisected ones, the MI-lesioned animals eventually developed bisymmetrical clonic convulsion with initial contralateral and then ipsilateral clonic involvement. At the secondary site, no positive transfer effect was noted in 1 CM-lesioned and 6/7 MI-lesioned cats. When the primary site was retested, a marked interference effect was observed. The lesion site responsible for these unique kindling features was in the rostral half of the MI with varying involvement of the nucleus centralis medialis (NCM). It is concluded that the MI plays an important role both for transhemispheric ictal propagation and for positive transfer effect in feline AM kindling. However, the mechanisms underlying these two phenomenon are unlikely to be the same since these effects can be totally divorced.

Platelet adhesion, contact phase coagulation activation, and C5a generation of polyethylene glycol acid-grafted high flux cellulosic membrane with varieties of grafting amounts

Grafting of polyethylene glycol chains onto cellulosic membrane can be expected to reduce the interaction between blood (plasma protein and cells) and the membrane surface. Alkylether carboxylic acid (PEG acid) grafted high flux cellulosic membranes for hemodialysis, in which the polyethylene glycol chain bears an alkyl group at one side and a carboxyl group at the other side, have been developed and evaluated. PEG acid-grafted high flux cellulosic membranes with various grafting amounts have been compared with respect to platelet adhesion, the contact phase of blood coagulation, and complement activation in vitro. A new method of quantitating platelet adhesion on hollow-fiber membrane surfaces has been developed, which is based on the determination of lactate dehydrogenase (LDH) activity after lysis of the adhered platelets. PEG acid-grafted high flux cellulosic membranes showed reduced platelet adhesion and complement activation effects in grafting amounts of 200 ppm or higher without detecting adverse effects up to grafting amounts of 850 ppm. The platelet adhesion of a PEG acid-grafted cellulosic membrane depends on both the flux and grafting amounts of the membrane. It is concluded that the grafting of PEG acid onto a cellulosic membrane improves its biocompatibility as evaluated in terms of platelet adhesion, complement activation, and thrombogenicity.

Evidence of secondary epileptogenesis in amygdaloid overkindled cats: electroclinical documentation of spontaneous seizures

Twenty-four spontaneously occurring convulsive seizures were documented by closed-circuit TV (CCTV)-EEG monitoring in 3 cats subjected to unilateral amygdaloid overkindling for < or = 2 years. Electroclinical manifestations suggested that the seizures originated in the kindled amygdala (AM) (10 seizures in 3 cats), contralateral AM (7 seizures in 3 cats), or ipsilateral frontal cortex (7 seizures in 1 cat). All seizures of AM origin except one occurred during sleep 23 h to 20 days after the last stimulation-induced kindled seizure and culminated in secondarily generalized seizures. The seizures of frontal cortical origin occurred during waking within 1 h of a kindled seizure and remained partial in nature. In seizures of AM origin, ictal patterns at the primary and secondary sites were mirror images of each other, but latency of onset of each seizure stage in seizures of secondary site AM origin was longer than that in seizures of primary site AM origin in 2 of the 3 animals. We conclude that the secondary epileptogenic functional alterations capable of producing clinical seizures do occur in AM-overkindled cats, but the seizures are not entirely independent of the primary kindled site.

Epilepsy in the elderly

PURPOSE

The aim of this study was to evaluate the clinical characteristics of elderly patients with epilepsy.

METHODS

We retrospectively reviewed the clinical records of 190 patients (104 males and 86 females) aged 60 years or older at the time of study.

RESULTS

Epilepsies were classified as generalized in 33 patients (17.4%), partial in 145 (76.3%), and undetermined in 12 (6.3%). Twenty-nine of 33 patients with generalized epilepsy were idiopathic, whereas all patients with partial epilepsy were symptomatic. Symptomatic partial epilepsy (SPE) began at all ages (2 to 81 years). Patients with early onset (< 20 years) showed the most unfavorable course in both seizure control and social adaptability. Patients with late onset (50 years or older) had no family history of epilepsy, and half of them had a past history of cerebrovascular disease or head injury as a presumed etiology. In patients with idiopathic generalized epilepsy (IGE), 25 of 29 had early onset, and a family history of epilepsy was found in 31%. Nineteen patients continued to have seizures after 50 years of age, albeit infrequently. Furthermore, 10 of them showed exacerbation around the age of 50.

CONCLUSIONS

Most of the late onset epilepsies were SPE with a relatively good prognosis. General belief has held that seizure outcome in IGE is favorable, but some IGE patients show an increased seizure propensity in old age.

Involvement of glutamatergic and GABAergic transmission in MK-801-increased gamma band oscillation power in rat cortical electroencephalograms

Hypofunction of the N-methyl-D-aspartic acid receptor (NMDAr) has been considered to play a crucial role in the pathophysiology of schizophrenia. In rodent electroencephalogram (EEG) studies, non-competitive NMDAr antagonists have been reported to produce aberrant basal gamma band oscillation (GBO), as observed in schizophrenia. Aberrations in GBO power have attracted attention as a translational biomarker for the development of novel antipsychotic drugs. However, the neuronal mechanisms as well as the pharmacological significance of NMDAr antagonist-induced aberrant GBO power have not been fully investigated. In the present study, to address the above questions, we examined the pharmacological properties of MK-801 (0.1 mg/kg)-increased basal GBO power in rat cortical EEG. Riluzole (3-10 mg/kg), a glutamate release inhibitor, reduced the MK-801-increased basal GBO power. In contrast, L-838,417 (1-3 mg/kg), an α2/3/5 subunit-selective GABAA receptor-positive allosteric modulator, enhanced the GBO increase. Antipsychotics such as haloperidol (0.05-0.3 mg/kg) and clozapine (1-10 mg/kg) dose-dependently attenuated the MK-801-increased GBO power. Likewise, LY379268 (0.3-3 mg/kg), an metabotropic glutamate 2/3 receptor (mGlu2/3 receptor) agonist, reduced the GBO increase in a dose-dependent manner, which was antagonized by an mGlu2/3 receptor antagonist LY341495. These results suggest that an increase in cortical GBO power induced by NMDAr hypofunction can be attributed to the aberrant activities of both excitatory pyramidal neurons and inhibitory interneurons in local circuits. The aberrant cortical GBO power reflecting cortical network dysfunction observed in schizophrenia might be a useful biomarker for the discovery of novel antipsychotic drugs.

Midline thalamic lesion and feline amygdaloid kindling. II. Effect of lesion placement upon completion of primary site kindling

Lesion placement in the massa intermedia (MI) prior to amygdaloid (AM) kindling distinctively modifies the pattern of transhemispheric ictal transmission to one similar to that of forebrain-bisected cats, and eliminates the positive transfer effect (Hiyoshi and Wada 1988). Since the mechanism of AM seizure development is not the same as that for maintenance of AM-kindled seizure susceptibility, the effect of MI lesioning on established primary site AM-kindled seizures and secondary site AM kindling was studied in 8 cats. Upon the first primary site AM restimulation following MI lesioning, all animals responded with established bisymmetrical generalized tonic-clonic convulsions. Subsequent secondary site AM kindling showed (1) a distinctively modified seizure pattern identical to that observed during primary site kindling in cats with 'prior-to-kindling' MI lesions, and (2) complete absence of positive transfer effects. At primary site retest, the animals again responded with an established bisymmetrical convulsion and a marked interference effect (negative aftereffect) was noted. It is concluded that (1) the positive transfer effect at the contralateral homotopic AM is primary site hemisphere dependent, (2) the MI is critically involved in this effect, (3) the MI is not critical for maintaining the bisymmetrical pattern of AM-kindled convulsions, and (4) the mechanisms underlying the transhemispheric positive and negative transfer effects are different.

Centrally induced feline emotional behavior and limbic kindling

The threshold intensity required for electrical hypothalamic/mesencephalic stimulation to elicit emotional behavior in cats was examined chronologically during limbic kindling (n = 9/5), and without kindling (n = 3/3) for a matching control period. After the completion of primary site amygdaloid (AM) or hippocampal (HIPP) kindling, the hypothalamic defensive behavior threshold showed a +/- 20% fluctuation from the prekindling baseline with a mean tendency for reduction as in the control animals. The flight behavior threshold increased in the kindled animals, and decreased in the controls; however, the degree of change was not statistically significant. In contrast, the mesencephalic defensive behavior threshold, which was quite stable in the controls, decreased significantly upon primary (mean -13.5%) and secondary site (mean -22.2%) AM kindling, whereas the flight and screeching (sound emission) behavior threshold remained unchanged throughout kindling. The decreased or unchanged thresholds for each behavior were independent of the timing of the hypothalamic/mesencephalic stimulation after kindled generalized convulsion. The decreased mesencephalic defensive behavior threshold persisted during a 1- to 3-month rest period without kindling stimulation. These findings suggest that acquisition of feline AM-kindled seizure susceptibility is associated with a lasting facilitation of midbrain (but not hypothalamic) excitability for defensive (but not flight) behavior.

Anticonvulsive effect of dapsone (4,4'-diaminodiphenyl sulfone) on amygdala-kindled seizures in rats and cats

Dapsone (4,4'-diaminodiphenyl sulfone; DDS), an established anti-leprosy drug, showed anticonvulsive effects in the amygdaloid kindling model of epilepsy. Single doses of the drug in rats (6.25-12.5 mg/kg, i.p.) suppressed the kindled seizures in a dose-dependent manner without overt behavioral toxicity. With repeated oral administration in cats, relatively higher initial doses (13-23 mg/kg) were required to obtain seizure suppression, and neurotoxic signs occurred within a few days with serum drug levels of approximately 20 micrograms/ml. Although dapsone showed anticonvulsive effects in both animal species, the effective serum levels overlapped the toxic levels reported in the clinical treatment of leprosy. In the majority of the cats, however, seizure suppression was maintained even after the discontinuation of dapsone with lower serum levels than those observed at the beginning of the seizure suppression. Therefore, dapsone would be useful as an antiepileptic drug only when long-term anticonvulsive efficacy is demonstrated using smaller doses comparable to those used in the treatment of leprosy.

Effect of obesity and insulin on immunity in non-insulin-dependent diabetes mellitus

OBJECTIVE

To understand the effect of obesity and insulin on immune functions in non-insulin-dependent diabetes mellitus (NIDDM).

SUBJECT

Fourteen obese NIDDM (body mass index (BMI)=30.6+/-1.1), seven non-obese NIDDM (BMI=24.2+/-0.5) and five obese non-NIDDM (BMI=28.3+/-0.67).

INTERVENTIONS

We first examined the influence of insulin on the proliferation of several human cell lines. Second, we compared several immune functions between obese and non-obese NIDDM, and obese non-NIDDM patients using peripheral blood mononuclear cells.

RESULT

Insulin decreased proliferation of T-cell lines but not that of other types of cell lines. Furthermore, obesity augmented the production of IL-1beta which could have cytotoxity against islet beta cells in NIDDM.

CONCLUSION

Our data suggested that the pathophysiology of NIDDM could be affected by the change of immunity due to obesity, and the treatment of obesity in NIDDM may be important from an immunological aspect.

Feline amygdaloid kindling and sleep

Six hourly polygraphic examinations of sleep organization were made before and after amygdaloid (AM) kindling in 7 cats. After completion of AM kindling and the repetitive induction of kindled convulsion, the percentage of time spent in rapid eye movement sleep (REMS) significantly decreased, although the animals began to spend significantly more time in sleep. This altered sleep pattern persisted during an extended 22.5 h recording in 2 cats. The decreased waking (W) and REMS, as well as the increased slow wave sleep (SWS), appeared to be due to changes in mean duration but not in the total number of periods. Suppression of REMS but not SWS was also manifested as a delayed onset of REMS following sleep onset, the latency of which remained constant upon placement of animals in the recording chamber. These changes in sleep organization were transient, however, as they returned completely to the baseline pre-kindling level after a rest interval of 3-4 weeks without kindling stimulation. It is concluded that sleep organization changes, particularly those characterized by the suppression of REMS, are independent of the acquisition of AM-kindled seizure susceptibility; rather they are the direct correlates of generalized convulsion itself.

Lasting nature of both transfer and interference in amygdaloid kindling in cats: observation upon stimulation with 11-month rest following primary site kindling

Eleven months after the completion of primary site amygdaloid (AM) kindling, three cats experienced kindling of the secondary site AM. At the secondary site, animals developed kindled seizure with a mean of eight stimulations, which was significantly fewer than the 29 required at the primary site, indicating a presence of a positive transfer effect. However, the ictal architecture of the secondary site-kindled seizure was significantly different from that of the primary site: in the former, there was a marked delay in secondary generalization, with individual kindled seizure having a significantly prolonged seizure duration. Both the transhemispheric positive and negative transfer effects observed with the secondary site AM kindling reflect the lasting nature of the neural remodeling induced by the primary site AM kindling. This finding may have clinical relevance.

Feline amygdaloid kindling and the sleep-waking pattern: observations on daily 22-hour polygraphic recording

For 22 h daily, polygraphic examination was made of sleep organization in four cats, both before and after amygdaloid (AM) kindling. After the completion of AM kindling and repetitive induction of kindled convulsion, the percentage of time spent in rapid eye movement sleep (REMS) significantly decreased, while the total sleep time (TST) remained unchanged. REMS suppression was most profound during the immediate postictal hours and continued through the 22-h period without a rebound increase. Slow wave sleep (SWS) was also suppressed during the postictal hours; however, this suppression was exceeded by that of REMS and was followed by a rebound increase. These changes in sleep organization were transient. During a rest interval of 2 months without kindled convulsions, they gradually disappeared and there was a complete recovery to the prekindling baseline. However, when the AM-kindled convulsion was reintroduced, there was an abrupt REMS suppression without TST change. We conclude that changes in sleep organization after AM kindling are (a) characterized by suppression of REMS and a compensatory increase in SWS, and (b) a direct but transient correlate of convulsion rather than of an acquired seizure susceptibility.

Small angle X-ray scattering studies on local structure of tobacco mosaic virus RNA in solution

Effects of temperature and ionic strength (S) on the local structure of tobacco mosaic virus RNA in phosphate buffer solution are studied by analyzing the small-angle X-ray scattering (SAXS) curves. The root-mean-square radius of a cross-section of RNA chain was kept at 0.845+/-0.005 nm over a wide range of S from 0.2 to 0.003 at 20 degrees C, whereas it gradually diminished from 0.85 to 0.61 nm when the temperature is raised from 20 to 50 degrees C at S = 0.2. Nevertheless, all of SAXS curves reflecting the backbone structures were equally mimicked by theoretical ones of freely hinged rod (FHR) models, i.e. several straight rods joined with freely hinged joints in the form of a combination of the letter Y, if the constituent rod lengths in the models are adjusted. From these facts, it is suggested that the local structure of the RNA chain in aqueous solution is characterized by an essential feature that unpaired bases in the partially double-stranded helix are constantly far isolated from each other along the helix and the rod-like structure of the helix is preserved over a range of helical contents. Such a characteristic local structure of the chain is entirely collapsed in the formamide solution at 50 degrees C.

Improvement of quality-of-life following resective surgery for temporal lobe epilepsy: results of patient and family assessments

In order to evaluate the quality-of-life (QOL) of epilepsy surgery patients, we surveyed patients' degree of life satisfaction and their families' degree of satisfaction with patient's status in a range of domains both pre- and post-operatively. Of 100 patient-family sets of surveys that were mailed out, 93 were completed and returned from patients and 91 from their families. All patients surveyed had temporal lobe epilepsy and had been followed for longer than 2 years after resective surgery. Patients and their families rated overall QOL as having markedly improved following surgery. However, they rated social domains of QOL, including role activities, financial status, and social and family relationships as having improved relatively little. Despite freedom from seizures, a few patients' families were dissatisfied with the patients' post-operative status, primarily for psychosocial reasons. Patients operated on at a later age reported little gains in life satisfaction following surgery. This study supports the conclusion that surgical intervention should occur before patients are subjected to the psychological conflicts and social handicaps associated with chronic intractable epilepsy.

Localizing value of seizure manifestations of temporal lobe epilepsies and the consequence of analyzing their sequential appearance

We investigated the localizing and lateralizing value of principal seizure manifestations in temporal lobe epilepsies (signal symptoms, oroalimentary automatisms, somatomotor manifestations, unilateral dystonic posturing, ictal speech, motionless stare) of 223 complex partial seizures in 50 patients. All the patients had invasive long-term monitoring with the combined implantation of intracerebral electrodes in and subdural electrodes on the bilateral temporal lobes. Postoperative freedom from seizures was ascertained for longer than one year. We found that 35 patients had amygdalohippocampal seizures and 15 had lateral temporal seizures. The value of the manifestations was established in relation to the site and side of seizure origin and to the progression of seizure discharges within the unilateral temporal lobe or to the contralateral cerebral hemisphere. Several signs among the manifestations were found to be reliable in predicting the site or side of the temporal lobe seizure focus. We emphasized the importance of investigating sequential changes of seizure manifestations in relation to ictal EEG findings by means of simultaneous recording.

Emotional facial expressions at the onset of temporal lobe seizures: observations on scalp and intracranial EEG recordings

The initial facial expressions of 195 complex partial seizures of 98 patients with temporal lobe epilepsy were reviewed in relation to the laterality and focality of electroencephalographic (EEG) seizure origin. A neutral expression was observed most often (71) followed in frequency by expressions of disgust (13), happiness (7) and sadness (7). There was no expression of anger, surprise and fear. No correlation was found between the type of facial expression and the side of seizure origin. However, among 27 patients examined by means of intracranial EEG recordings, it was evident that a disgust expression occurred with oro-alimentary automatisms at the beginning of mesial temporal lobe seizures, whereas a happy one occurred without oro-alimentary automatisms at the beginning of lateral temporal lobe seizures. Although the facial expressions were not always related to the concurrent ictal emotion, it appeared that the majority of the patients with the disgust expression had autonomic features, while those of the happy/sad expression had psychic/sensory ones. It was concluded that (1) a disgust expression occurs as an indirect consequence of "crude sensation," while a happy/sad expression occurs as a direct consequence of "elaborate mental state" (Jackson) and (2) facial expressions must be reviewed in relation to focality rather than laterality in temporal lobe seizures.

[Emphysematous cystitis and neuropathy; a report of the case with diabetes mellitus]

A study was made of a 55 years old male, who suffered from emphysematous cystitis with diabetes mellitus. He had multiple complications due to diabetic neuropathy such as foot ulceration, oculomotor nerve palsy, peroneal nerve palsy and a neurogenic bladder. Klebsiella pneumoniae and Pseudomonous aeruginosa were cultured from urine specimens. There have been only 19 reported cases of emphysematous cystitis since 1962. Fourteen of these cases had diabetes mellitus.

Feline agenesis of the corpus callosum

The unusual pattern of seizure development and developed seizure in a cat kindled at the ventral hippocampus is discussed in the light of agenesis of the corpus callosum (CC). In this animal, not only the CC but also the hippocampal commissure was completely absent and the dorsal portion of the septal area was separated in the midline. There was no other morphological anomaly except for slightly enlarged lateral ventricles. No behavioral or physical peculiarities were noted. The unusual profile of kindling in this animal was characterized by (a) very rapid kindling at the primary site, (b) the lateralized nature of the kindled primary site convulsion preceded by repetitive and violent contralateral axial rotation, and (c) the complete absence of positive transfer effect expected at the contralateral homotopic secondary site. These features are strikingly reminiscent of the pattern of amygdaloid kindling in forebrain-bisected cats. These observations add strength to our hypothesis that the CC (and possibly the hippocampal commissure) is the major anatomic substratum for convulsive generalization and the transhemispheric positive transfer effect in feline limbic kindling.

Failure of nine-month phenobarbital administration to reverse amygdaloid-kindled seizure susceptibility in cats

Upon completion of left amygdaloid kindling, 4 cats underwent long-term phenobarbital administration during the subsequent 5- to 9-month rest period. Plasma phenobarbital levels were maintained above 15 to 20 micrograms/ml and were restimulated following plasma phenobarbital washout. Three cats served as nonmedicated controls. All 7 cats were subjected to repeated 6-hour sleep monitoring for observation of interictal discharges, which were observed most often in the immediate postictal period. Their frequency decreased gradually throughout the experiment in both the medicated and control animals, but they never completely disappeared except from the contralateral amygdala in 1 medicated animal. Upon primary site restimulation, all of the medicated animals responded with a generalized convulsion once the afterdischarge was induced. When these animals underwent secondary-site amygdaloid kindling, 3 showed a positive transfer effect. The findings suggest that although phenobarbital is a potent anticonvulsant, it has little effect on the acquired seizure susceptibility of previously amygdaloid kindled cats.