Japanese civilian and US military interaction in the evacuation of casualties from Camp Fuji

Historically, if US soldiers at Camp Fuji become severely ill or suffer trauma, they are transported by the ground ambulance, as the doctor-led air ambulance in eastern Shizuoka has never been permitted to land at Camp Fuji. However, it is widely recognised that severely ill or traumatised patients require time-dependent medical management. It was therefore agreed to undertake a joint exercise between the US medical assets of Camp Fuji and the doctor helicopters in eastern Shizuoka prefecture in evacuating a simulated severely ill or traumatised US soldier. The aim of this article is to describe the background and rationale between this collaboration between the civilian Japanese air ambulance and the US medical assets in Camp Fuji.

Biomimetic Chemical Sensing by Fluorescence Signals Using a Virus-like Particle-Based Platform

The chemical receptors present in living organisms are promising tools for developing biomimetic chemical sensors. However, these receptors require lipid membranes for functioning under physiological conditions, which prevents their utilization in the production of cell-free in vitro chemical sensing systems. Here, we report the development of a cell-free biomimetic sensing platform using virus-like particles (VLPs) with intact ligand-gated Ca²⁺ channels and genetically encoded Ca²⁺ indicator (GECI). We observed that targeting GECI to the plasma membrane was essential for efficient loading GECI in the VLPs. Although the physiological Ca²⁺ concentration [Ca²⁺] maintained in the cells was low (∼10 nM), the concentration in the VLPs was high. This prevented the detection of the increase in [Ca²⁺] caused by binding of the ligand to the receptor. To address this problem, we employed Lyn-R-CEPIA1, which had low affinity for Ca²⁺, and a membrane targeting sequence. Thus, we succeeded in monitoring the activation of cyclic nucleotide-gated channels (CNG) on the VLPs by measuring the increase in fluorescence of Lyn-R-CEPIA1. Our VLP-based sensing system can act as a fundamental platform for all kinds of ligand-gated channels.

Urinary WT1-positive cells as a non-invasive biomarker of crescent formation

OBJECTIVE

The purpose of this study was to assess the relationship between urinary WT1-positive cells (podocytes and active parietal epithelial cells) and WT1-positive cells in renal biopsy to investigate whether urinary WT1-positive cells are useful for detection of crescent formation.

METHODS

Fifty-two patients with kidney disease were investigated (15 cases with crescentic lesions and 37 cases with non-crescentic lesions) for immunoenzyme staining using anti-WT1 antibody for urine cytology and renal biopsy. Numbers of WT1-positive cells in urine and renal biopsy were counted.

RESULTS

There was no correlation between urinary WT1-positive cells and WT1-positive cells in renal biopsy. However, the number of urinary WT1-positive cells in patients with crescentic lesions was significantly higher than in patients with non-crescentic lesions. In addition, the best cut-off value to detect patients with crescentic lesions using urinary was 5 cells/10-mL (area under the concentration-time curve=0.735).

CONCLUSIONS

The results of our study suggest urinary WT1-positive cells can be used to detect patients with crescent formation using 5 cells/10-mL cutoff value. WT1-positive glomerular podocytes and parietal epithelial cells may be shed into urine in active glomerular disease. This study, investigating the relationship between WT1-positive cells in urine and in the renal biopsy found no correlation; however, the results do suggest that, using a cutoff value of 5 cells/10 mL, WT1 positive urinary cells can be used to detect patients with crescent formation.

A Distinct Subpopulation of Bone Marrow Mesenchymal Stem Cells, Muse Cells, Directly Commit to the Replacement of Liver Components

Genotyping graft livers by short tandem repeats after human living-donor liver transplantation (n = 20) revealed the presence of recipient or chimeric genotype cases in hepatocytes (6 of 17, 35.3%), sinusoidal cells (18 of 18, 100%), cholangiocytes (15 of 17, 88.2%) and cells in the periportal areas (7 of 8, 87.5%), suggesting extrahepatic cell involvement in liver regeneration. Regarding extrahepatic origin, bone marrow mesenchymal stem cells (BM-MSCs) have been suggested to contribute to liver regeneration but compose a heterogeneous population. We focused on a more specific subpopulation (1-2% of BM-MSCs), called multilineage-differentiating stress-enduring (Muse) cells, for their ability to differentiate into liver-lineage cells and repair tissue. We generated a physical partial hepatectomy model in immunodeficient mice and injected green fluorescent protein (GFP)-labeled human BM-MSC Muse cells intravenously (n = 20). Immunohistochemistry, fluorescence in situ hybridization and species-specific polymerase chain reaction revealed that they integrated into regenerating areas and expressed liver progenitor markers during the early phase and then differentiated spontaneously into major liver components, including hepatocytes (≈74.3% of GFP-positive integrated Muse cells), cholangiocytes (≈17.7%), sinusoidal endothelial cells (≈2.0%), and Kupffer cells (≈6.0%). In contrast, the remaining cells in the BM-MSCs were not detected in the liver for up to 4 weeks. These results suggest that Muse cells are the predominant population of BM-MSCs that are capable of replacing major liver components during liver regeneration.

Influence of the Circulating Current on the Propagation of the Change in Membrane Potential

The propagation of the change in potential differences across liquid membranes from the potential-sending cell to the potential-receiving cell was investigated by use of a system combined with three liquid membrane cells, which were composed of two aqueous phases and a 1,2-dichloroethane solution phase. The ionic composition of one potential-sending cell (S) was identical to that of the receiving cell (Rec), and that of another potential-sending cell (Ap) was different from that of the Rec. When the connection of cell Rec was switched from cell S to cell Ap, the change in the membrane potential was caused by the circulating current. The greater the ratio of the interfacial area of the membrane of cell Ap to that of cell Rec, the faster the change in the membrane potential propagated from cell Ap to cell Rec.

Control of Spontaneous Ca2+ Transients Is Critical for Neuronal Maturation in the Developing Neocortex

Neural activity plays roles in the later stages of development of cortical excitatory neurons, including dendritic and axonal arborization, remodeling, and synaptogenesis. However, its role in earlier stages, such as migration and dendritogenesis, is less clear. Here we investigated roles of neural activity in the maturation of cortical neurons, using calcium imaging and expression of prokaryotic voltage-gated sodium channel, NaChBac. Calcium imaging experiments showed that postmigratory neurons in layer II/III exhibited more frequent spontaneous calcium transients than migrating neurons. To test whether such an increase of neural activity may promote neuronal maturation, we elevated the activity of migrating neurons by NaChBac expression. Elevation of neural activity impeded migration, and induced premature branching of the leading process before neurons arrived at layer II/III. Many NaChBac-expressing neurons in deep cortical layers were not attached to radial glial fibers, suggesting that these neurons had stopped migration. Morphological and immunohistochemical analyses suggested that branched leading processes of NaChBac-expressing neurons differentiated into dendrites. Our results suggest that developmental control of spontaneous calcium transients is critical for maturation of cortical excitatory neurons in vivo: keeping cellular excitability low is important for migration, and increasing spontaneous neural activity may stop migration and promote dendrite formation.

Exendin-4 regulates the expression of the ATP-binding cassette transporter A1 via transcriptional factor PREB in the pancreatic β cell line

BACKGROUND

PRL regulatory element-binding (PREB) protein is a transcription factor that regulates insulin promoter activity in the rat anterior pituitary. The PREB protein is expressed not only in the anterior pituitary but also in pancreatic β cells. Previously, we have reported that PREB plays an important role in glucose-mediated insulin gene expression in pancreatic β cells. The ATP-binding cassette transporter A1 (ABCA1) in pancreatic β cells influences insulin secretion and glucose homeostasis. Exendin-4 (Ex-4), a longacting agonist of the glucagon-like peptide 1, stimulates ABCA1 expression in pancreatic β cells.

AIMS

In this study, we examined the role played by PREB in Ex-4-induced ABCA1 expression in pancreatic β cells.

MATERIAL/SUBJECTS AND METHODS

PREB mRNA and protein expression were evaluated in pancreatic β cell line (INS-1 cells) treated with Ex-4 (10 nM).

RESULTS

Ex-4 stimulated PREB protein and mRNA expression in INS-1 cells. PREB stimulated the activity of the luciferase reporter protein that was under the control of the ABCA1 promoter. Chromatin immunoprecipitation assay showed that PREB mediates its transcriptional activity by directly binding to the ABCA1 promoter region. Finally, we used small interfering RNA to inhibit PREB expression in the cells and demonstrated that the knockdown of PREB expression attenuated the effects of Ex-4 on ABCA1 expression.

CONCLUSION

PREB mediates Ex-4-stimulated transcription of the ABCA1 gene in pancreatic β cells.

Malignant adenomyoepithelioma of the breast with lung metastases: report of a case

Adenomyoepithelioma of the breast is a rare lesion, and has a bicellular pattern of epithelial and myoepithelial cells which are regularly distributed in the tubular structures based on the histologic and ultrastructural features. It is thought to be a benign or a low-grade malignant disease. We herein describe a case of malignant adenomyoepithelioma of the breast with lung metastases in an 86-year-old woman. A primary massive tumor in the left breast grew rapidly within a short period of time. A simple mastectomy with sampling of the axillary lymph nodes was performed. The obtained lymph nodes did not include any metastatic lesions. Malignancy was evidenced by the presence of a high mitotic rate and severe nuclear atypia. Three months after the operation, radiology showed multiple lung metastases, and the patient died 2 weeks thereafter. Reviewing the literature, nine similar cases were reported, and the prognosis of malignant adenomyoepithelioma of the breast with distant metastases was very poor with the time of recurrence varying after initial treatments. Malignant adenomyoepithelioma should be followed up with careful screening for distant metastases.

Sarcomatoid hepatocellular carcinoma with chondroid variant: case report with immunohistochemical findings

A case of sarcomatoid hepatocellular carcinoma (HCC) with a chondroid variant in a 72-year-old woman is reported. Histologically, the tumor consisted of typical HCC of adult type, with an adenocarcinoma-like structure and a sarcomatoid component containing multinodular chondroid foci. Transition from carcinoma to sarcomatoid component was observed. The cells containing mucus were extremely few in adenocarcinoma-like structures. Immunohistochemically, other than typical HCC, some of the chondroid cells, adenocarcinoma-like cells and sarcomatoid cells were positive for alpha-fetoprotein.

Intrathyroidal branchial cleft-like cyst in chronic thyroiditis

An extremely rare case of intrathyroidal branchial cleft-like cyst is reported. A 71-year-old man complained of a growing mass in the right lateral neck. A cystic mass in the upper lobe of the right thyroid was demonstrated by ultrasonography and computed tomography. The surgical specimen revealed a cystic mass with dense fibrous capsule, 22 x 20 x 10 mm in size. Microscopically, the cyst walls and the surrounding thyroid tissue contained severe lymphoid cell infiltration with lymphoid follicle. Squamous epithelium lined the cyst wall. Immunohistochemically, squamous epithelium was positive for keratin, cytokeratin 19, carcinoembryonic antigen, and epithelial membrane antigen, but negative for calcitonin and chromogranin A. The patient is currently well with no evidence or recurrence for 43 months.

Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones

We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78-110mm. Angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%-0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones.

A case of infantile rhabdomyofibrosarcoma with immunohistochemical, electronmicroscopical, and genetic analyses

A case of infantile rhabdomyofibrosarcoma arising on the buttocks of a 15-month-old boy is reported with histological, immunohistochemical, electronmicroscopical, and cytogenetic findings. Histological examination showed a proliferation of spindle-shaped cells in a fasciculated pattern, with occasional rounded rhabdomyoblastic cells with abundant eosinophilic cytoplasm. Immunohistochemically, the tumor cells expressed desmin and MyoD1 but were only weakly positive for myoglobin. No clear rhabdomyoblastic features were observed by electronmicroscopic examination. Chromosome analysis showed a clone of 46, XY, der(2)t(2;11)(q37;q13), different from any karyotypic abnormality in the original report of this neoplasm. Loss of heterozygosity at 11p15.5, the most frequent genetic alteration in embryonal rhabdomyosarcoma, was not detected. The low degree of striated muscle differentiation and tumor localization supported the diagnosis of infantile rhabdomyofibrosarcoma rather than spindle-cell rhabdomyosarcoma in this case. The present case has been uneventful as of 25 months after surgery. The rather long recurrence-free period, which has not been reported in previous cases, may be attributable to chemotherapy-induced rhabdoid differentiation of the tumor cells.

Loss of heterozygosity in actinic keratosis, squamous cell carcinoma and sun-exposed normal-appearing skin in Japanese: difference between Japanese and Caucasians

Actinic keratosis (AK) has been considered to be a precursor of squamous cell carcinoma (SCC). However, based on epidemiological and molecular studies, it has become questionable to regard AK as a precancerous lesion. We analyzed 37 AKs and 14 sporadic SCCs using six microsatellite markers in order to elucidate if any genetic instability or loss of heterozygosity (LOH) was implicated in tumorigenesis and progression of non-melanocytic skin tumor. Microsatellite instability (MSI) was not found in any of the AKs or SCCs indicating that genetic instability has little implication in the tumorigenesis of sporadic non-melanocytic skin tumor. LOH was found in seven of 37 lesions of AK, but in only one of 14 lesions of SCC. The significantly lower frequency of LOH than that previously reported in Caucasians suggested that the molecular pathogenesis of AKs and SCCs might be different between Japanese and Caucasians. The higher frequency of LOH in AKs than in SCCs in the present study supported the previous epidemiological and molecular studies that AK was not likely to proceed to SCC. LOH was also demonstrated in histologically normal-appearing skin in three cases suggesting that genetic alteration occurs before histological change appears in the sun-exposed skin.

[Use of personal computers by diplomats of anesthesiology in Japan]

Use of personal computers by diplomats of the Japanese Board of Anesthesiology working in Japanese university hospitals was investigated. Unsigned questionnaires were returned from 232 diplomats of 18 anesthesia departments. The age of responders ranged from twenties to sixties. Personal computer systems are used by 223 diplomats (96.1%), while nine (3.9%) do not use them. The computer systems used are: Apple Macintosh 77%, IBM compatible PC 21% and UNIX 2%. Although 197 diplomats have e-mail addresses, only 162 of them actually send and receive e-mails. Diplomats in fifties use e-mail most actively and those in sixties come second.

Uterine leiomyosarcoma metastasis to the skull--case report

A 54-year-old female presented with a rare uterine leiomyosarcoma metastasis to the skull appearing as a gross mass beneath her scalp. She had no neurological or other physical symptoms on admission. Computed tomography and magnetic resonance imaging demonstrated an enhanced dumbbell-shaped mass at the mid-frontal region beneath the scalp. The tumor was totally removed with normal surrounding bone and dura. The histological diagnosis was leiomyosarcoma. Her postoperative course was uneventful, and she received adjuvant chemotherapy. However, multiple distant bone metastases developed 1 year later. Immediate and radical resection of such tumors is recommended.

[A clinical study of the continuous intra-arterial infusion chemotherapy of Ewing's sarcoma]

Eight cases of Ewing's sarcoma were treated by continuous intra-arterial infusion chemotherapy (i.a. infusion). Five cases gave no evidence of disease (mean 4 yr. 7 mos.), and 3 cases died (3 mos, 1 yr. 11 mo, 2 yrs. 5 mos.). The term of i.a. infusion was 3 mos. to 2 yrs. 3 mos. (mean 12 mos). Except in 2 cases, the primary tumors were suppressed by i.a. infusion, so these cases were not operated and no relapse resulted. The cumulative survival rate by Kaplan-Meier's method was 56.3%. The i.a. infusion for Ewing's sarcomas implies the possibility of limb-saving treatment with no operation.

[Disproportionately large, communicating fourth ventricle; report of 4 cases]

Although both "Isolated Fourth Ventricle" (IFV) and "Disproportionately Large, Communicating Fourth Ventricle" (DLCFV) are the clinical-radiologic entities characterized by a dilatation of the fourth ventricle, DLCFV must be separated from IFV because of its apparent patency of the aqueduct. In some Japanese literature, however, there was some confusion concerning DLCFV and so-called "reversible DLCFV" or IFV with "one way aqueduct". In this paper, comparing DLCFV with IFV, a reasonable pathogenesis of DLCFV was discussed on the basis of clinico-radiological analysis of four cases of DLCFV. Our tentative conclusion is as follows: 1) Whether there is radiologic aqueductal patency or not, the term of DLCFV should not be primarily reserved for patients who have had shunting of the lateral ventricle for previous hydrocephalus." 2) It was strongly suggested that a mechanism involved in the development of DLCFV was the formation "membranous occlusion" in/or near the foramen Magendie.

[Molecular analysis of an African family with sickle cell disease and alpha-thalassemia-2]

An etiological examination was performed on the DNA of a 13-year-old Zairean girl, who had some abnormalities in hematological and red cell morphological examinations and was homozygote for an abnormal Hb like HbS. DNA was amplified by the PCR method to obtain 1.7 kb size DNA containing the 5' region of the beta globin gene. The amplified DNA was digested with Eco 81 I and electrophoresis of the digest revealed the absence of its active site, which is on codons beta 5-7 (CCTGAGGAG) of the normal DNA. Sequencing of the cloned DNA by the dideoxy method confirmed that the codon beta 6 (GAG, Glu) mutated to a new codon GTG (Val) which is the beta S globin gene producing abnormal HbS. The haplotype of the chromosome having beta S gene was --+---++, which is the most common type in Zaire area. On the other hand, when the genomic DNA was digested with Bgl II or Bam HI and hybridized to an alpha probe, a fragment (16 kb/Bgl II or 10.5 kb/Bam HI) in addition to the normal ones (12.5 and 7.5 kb/Bgl II or 14 kb/Bam HI) was observed. This resulted from the deletion of 3.7 kb from the alpha gene arrangement, which led to alpha-thalassemia-2 (genotype: alpha 3.7-/alpha alpha). A family study demonstrated that her parents were heterozygote for HbS and her father had alpha-thalassemia-2.

[Clinical studies on preoperative continuous intra-arterial chemotherapy in the treatment of malignant soft tissue tumors]

Preoperative continuous intra-arterial chemotherapy combined with surgery in the treatment of malignant soft tissue tumors has been used since 1971 in our clinic. We treated thirty-eight patients, and twenty-five of them underwent preoperative intra-arterial chemotherapy and surgery. The diagnoses were liposarcoma (5), synovial sarcoma (4), rhabdomyosarcoma (2), angiosarcoma (2), malignant schwannoma (2), malignant lymphoma (2) and 8 other types of tumors. From the standpoint of local failures, there was only one recurrent case. Eighteen patients are alive now without evidence of disease. The 10-year cumulative survival rate for cases treated with intra-arterial chemotherapy was 69.5%, as compared with 24.9% of cases without intra-arterial chemotherapy. Therefore we conclude that preoperative continuous intra-arterial chemotherapy is a very effective method in the treatment of malignant soft tissue tumors.

[Application of the polymerase chain reaction (PCR) in the diagnosis of Hb S-beta(+)-thalassemia]

Isoelectric focusing of the hemolysate prepared from a two-year-old American black boy with microcytic hypochromia showed the presence of a high percentage (63.3%) of such Hb variant as Hb S, while the levels of Hb A, Hb F and Hb A2 were 20.0%, 12.7%, and 4.0%, respectively. The ratio of the non-alpha-chain to the alpha-chain of the biosynthesized globin chains was 0.49. The variant was identified as Hb S by amino acid analysis of the abnormal peptide (beta T-1) and digestion of DNA amplified by the polymerase chain reaction with enzyme Eco 81 I. This was further confirmed by DNA sequencing. DNA sequencing of a beta-gene without the beta s-mutation revealed a nucleotide change of T to C in the polyadenylation signal sequence AATAAA 3' to the beta-gene, resulting in beta(+)-thalassemia. These results are consistent with the existence of a beta s-gene and a beta(+)-thalassemia gene in trans.

Hb Isehara (or Hb Redondo) [beta 92 (F8) His----Asn]: an unstable variant with a proximal histidine substitution at the heme contact

A 50-year-old Japanese female patient was found to have hemolytic anemia. Isoelectrofocusing of her hemolysate revealed two abnormal hemoglobin bands, one of which was very close to the Hb A2 band, and the other between the Hb A2 and Hb F bands. CM-cellulose column chromatography of the globin prepared from the abnormal hemoglobin showed that the abnormal chain eluted faster than the normal beta and delta chains; the beta X chain, however, did not separate from the normal beta chain in urea cellulose acetate electrophoresis. An instability test of the patient's hemolysate revealed the presence of an unstable component. Structural analysis of the abnormal beta chain indicated that the histidine residue at beta 92(F8) was replaced by an asparagine or aspartic acid residue. DNA amplified by polymerase chain reaction was sequenced by the dideoxy method. The nucleotide sequence of the beta 92 codon was AAC instead of CAC, suggesting that the amino acid substitution corresponded to His----Asn, which is the same as is found in Hb Redondo or beta 92(F8)His----Asn----Asp.

[Structural analysis of abnormal hemoglobin by the polymerase chain reaction (PCR) of genomic DNA]

Determination of the primary structure of abnormal Hbs on the basis of DNA sequencing of the globin gene obtained from a carrier of abnormal Hb was performed. DNA obtained from the leukocytes of the peripheral blood was amplified by the polymerase chain reaction (PCR) using the proper amplification primer set. Amplified DNA was digested with two different restriction endonucleases and cloned to vector M 13 mp 18 or mp 19, which had been digested with the same enzymes. DNA sequencing was done by the dideoxy chain termination method using T 7 DNA polymerase, and the abnormal Hbs whose primary structure was determined were as follows: Hb Fukuoka [beta 2 His(CAC/T)----Tyr(TAT)], Hb Machida [beta 6 Glu(GAG)----Gln (CAG)], Hb Hope [beta 136 Gly(GGT)----Asp(GAT)], Hb Hiroshima [beta 146 His(CAC)----Asp(GAC)] and Hb Kodaira [beta 146 His(CAC)----Gln(CAA)]. This method for determining the primary structure of abnormal Hbs might be more effective than the ordinary method, which involves amino acid analysis and amino acid sequencing of the abnormal peptide obtained from abnormal Hb.

[Continuous intra-arterial infusion chemotherapy for malignant bone and soft tissue tumors in pelvis and trunk areas]

We evaluated the effectiveness of intra-arterial infusion chemotherapy for 21 cases of malignant bone and soft tissue tumors in the pelvis and trunk areas. Eight cases are alive for one or two years without operation. In all cases, pain was decreased and quality of life improved. We concluded that intra-arterial infusion chemotherapy is one of the useful treatments for malignant bone and soft tissue tumors in the pelvis and trunk areas.

[Comparative pharmacokinetics of pipecuronium bromide, pancuronium bromide and vecuronium bromide in anesthetized man]

The pharmacokinetics of pipecuronium bromide was studied in 9 male patients (ASA class 1-2, 20-65 years of age). Following a single intravenous dose of pipecuronium 0.08 mg.kg-1, plasma levels were measured by capillary gas chromatography. Plasma concentration-time curves were evaluated by fitting the data to a bi-exponential equation. The pharmacokinetic parameters of pipecuronium were compared with those of pancuronium (0.08 mg.kg-1) and vecuronium (0.08 mg.kg-1) previously obtained under the same anesthesia (66% N2O, 33% O2 and 1% halothane). With pipecuronium, following pharmacokinetic parameters were obtained; distribution half-life; T1/2 alpha = 3.9 +/- 0.7 min (mean +/- SEM), elimination half-life; T1/2 beta = 102 +/- 12 min, volume of the central compartment; V1 = 95 +/- 13 ml.kg-1, volume of distribution at steady state; Vdss = 264 +/- 41 ml.kg-1, clearance; Cl = 1.8 +/- 0.2 ml.min-1.kg-1. Microconstants of two-compartment open models (k12, k21, k10) were also calculated. Using Mann-Whitney's U-test, these parameters of pipecuronium were compared with those of pancuronium (n = 3) and vecuronium (n = 4). V1 and Vdss of pipecuronium were significantly larger than those of pancuronium (V1; 38 +/- 12 ml.kg-1 and Vdss; 120 +/- 4 ml.kg-1) (both P less than 0.10). Reflecting the larger central volume of pipecuronium, pipecuronium tended to have a larger clearance than that of pancuroniumu (Cl; 1.1 +/- 0.2 ml.min-1.kg-1).(ABSTRACT TRUNCATED AT 250 WORDS)

[Preoperative continuous intra-arterial infusion chemotherapy as part of a local regional treatment of osteosarcoma of the extremities]

Preoperative continuous intra-arterial chemotherapy combined with surgery in the treatment of osteosarcoma has been since 1968 in our clinic. Sixty-three cases with osteosarcoma of the extremities were evaluated in this study. Eighteen of these cases underwent limb salvage procedures. There were three intralesional, eleven marginal and four wide excision cases. From the standpoint of local failures, there were only two recurrent cases. One occurred after a marginal excision and the other after an intralesional excision. The 5-year cumulative survival rate for limb salvage cases was 56.0%, as compared with 40.6% of the amputation cases. Therefore we conclude that preoperative continuous intra-arterial infusion chemotherapy is a very effective method as a local regional therapy for osteosarcoma of the extremities.

[Limb-saving surgery of malignant bone tumors using massive bone grafts]

The artificial materials in limb-saving surgery pose problems such as the age of patient, tolerance and stability. Thus, massive bone grafting should be reconsidered. In our clinic, out of 78 patients having malignant bone tumors, 29 received limb-saving surgery, and 10 of these cases received massive bone grafting using autografts and/or frozen allografts between 1968 and 1987. There were 7 cases with osteosarcoma, 1 case with mesenchymal chondrosarcoma, 1 case with leiomyosarcoma and 1 case with malignant fibrous histiocytoma. There were 5 males and 5 females ranging in age from 11 years to 44 years, and averaging 21 years. According to Enneking's staging system, these were all II-B cases. The median follow-up period was 71 mos, ranging from 13 to 239 mos. According to the modified Amago evaluation method, 80% of these cases had an excellent prognosis, one had a recurrence, but in all cases good bone union and stability were achieved without immunological reaction. Therefore we conclude that massive bone grafts in cases of malignant bone tumor surgery is a very beneficial method.

[99mTc-MAA perfusion studies in the treatment of preoperative intra-arterial infusion chemotherapy of malignant bone and soft tissue sarcoma]

Preoperative intra-arterial continuous chemotherapy combined with surgery in the treatment of malignant bone and soft tissue sarcomas has been used since 1968 in our clinic. This approach offers a theoretical advantage over systemic chemotherapy in that it delivers higher concentrations of chemotherapeutic agents to the tumor bed without increasing systemic toxicity. Tumor response depends on tumor sensitivity and the maximum amount of agent which is deliverable to the tumor tissues, so it is important to maintain a proper catheter placement to obtain good tumor response. 99mTc-Labeled macroaggregated albumin (99mTc-MAA) perfusion studies were carried out 19 patients who had histologically proven malignant bone and soft tissue sarcomas. The use of 99mTc-MAA perfusion studies in the treatment of intra-arterial chemotherapy offers an excellent way to evaluate catheter placement and tumor perfusion, in addition to providing a way to evaluate tumor A-Vshunts with lung scanning. The dynamic images of 99mTc-MAA obtained at each stage of the chemotherapy period also demonstrate the degree of tumor tissue response to intra-arterial chemotherapy. Therefore we conclude that 99mTc-MAA perfusion combined with preoperative intra-arterial infusion is a very useful method in cases involving limb salvage surgery.

[Disproportionately large communicating fourth ventricle--report of 2 cases]

A term of 'disproportionately large, communicating fourth ventricle' (DLCFV) was first proposed by in Harwood-Nash in 1980. It is somewhat different from the well known clinical entity of 'isolated or trapped fourth ventricle', because of apparent patency of aqueductal canal. Two cases of typical DLCFV encountered in our clinic were described. First patient was a 24 year old man in whom this condition developed following operations for lumber disc and second patient was 22 year old woman in whom the disease developed after subarachnoid hemorrhage. In both cases, main symptoms were attributable to hydrocephalus but three posterior fossa symptoms, nystagmus, Parinaud' sign and truncal ataxia were also characteristic. On the CT scan, the fourth ventricle was extraordinarily enlarged. Patency of the aqueductal canal was demonstrated by air study or Conray and Metrizamide ventriculography. On the other hand, occlusion was demonstrated or highly suspected in or near the foramina Magendie and Luschka. After a routine ventriculo-peritoneal shunt operation, the fourth ventricle decreased in size and the symptoms were immediately relieved. Plausible explanation for mechanism involved in occurrence of DLCFV were (1) occlusion process in or near the fourth ventricle outlets seems to be crucial in this pathologic condition. Collision of CSF pulse waves against the obstruction may yield a water hammer effect on the fourth ventricle. (2) abnormal weakness of the brain stem parenchyma around the fourth ventricle to CSF pressure may be another contributory factor.

[Chronic subdural hematoma associated with arachnoid cyst--study of the mechanism of its development]

A significant number of cases of chronic subdural hematoma associated with middle fossa arachnoid cyst has been reported in literature, but sufficiently tenable explanation for co-occurrence of both lesions has not yet proposed. In this study, authors try to elucidate mechanisms involved in development of chronic subdural hematoma and arachnoid cyst in the same patient. Eighteen cases with arachnoid cyst in the middle fossa were diagnosed by CT scan during last 5 years in our institute. Among these, five patients had chronic subdural hematoma additionally to their middle fossa arachnoid cyst. Analysis of clinical, roentgenological data and operative findings in our five cases and reviewing of cases reported so far in the literature makes clear the following characteristics in this pathological condition. 1) Patients of chronic subdural hematoma associated with arachnoid cyst were obviously younger than patients with usual chronic subdural hematoma. 2) Chronic subdural hematoma developed in the same side to the associated arachnoid cyst. 3) Characteristic changes in the skull on x-ray films indicated the long lasting existence of middle fossa arachnoid cyst. On the other hand, history of cases suggested that chronic subdural hematomas had developed within recent 1-3 months. 4) Intracranial pressure tended to remain normal or slightly elevate. 5) Abnormal, small veins which run on the surface of the membranous capsule of arachnoid cyst and bridge the Sylvian fissure were not infrequently found at operation. These veins were not able to visualized on routine angiography. On the basis of these clinical and pathological characteristics, authors infer a mechanism for development of subdural hematoma associated with arachnoid cyst. The presence of middle fossa arachnoid cyst must increase a compressibility of the intracranial content, especially of the ipsilateral cerebral hemisphere and it predisposes for development of chronic subdural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)