Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm.

INTRODUCTION: Although thoracic endovascular aortic repair (TEVAR) has become a promising treatment for complicated acute type B dissection, its role in treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA) is still limited owing to persistent retrograde flow into the false lumen (FL) through abdominal or iliac re-entry tears. REPORT: A case of chronic post-dissection TAA treatment, in which a dilated descending FL ruptured into the left thorax, is described. The primary entry tear was closed by emergency TEVAR and multiple abdominal re-entries were closed by EVAR. In addition, major re-entries at the detached right renal artery and iliac bifurcation were closed using covered stents. To close re-entries as far as possible, EVAR was carried out using the chimney technique, and additional aortic extenders were placed above the coeliac artery. A few re-entries remained, but complete FL thrombosis of the rupture site was achieved. Follow-up computed tomography showed significant shrinkage of the FL. DISCUSSION: In treating post-dissection TAA, entry closure by TEVAR is sometimes insufficient, owing to persistent retrograde flow into the FL from abdominal or iliac re-entries. Adjunctive techniques are needed to close these distal re-entries to obtain complete FL exclusion, especially in rupture cases. Recently, encouraging results of complete coverage of the thoraco-abdominal aorta with fenestrated or branched endografts have been reported; however, the widespread employment of such techniques appears to be limited owing to technical difficulties. The present method with multiple re-entry closures using off the shelf and immediately available devices is an alternative for the endovascular treatment of post-dissection TAA, especially in the emergency setting.

Epidermal growth factor enhances lipopolysaccharide-induced procoagulant activity on the cell surface of endothelial cells.

Endotoxin [lipopolysaccharide (LPS)] and some cytokines are known to induce tissue factors with the expression of procoagulant activity (PCA) on the cell surface of endothelial cells. We established a modified quantitative procedure for PCA expressed on the cell surface, and studied the effects of serum and epidermal growth factor (EGF) on the LPS-induced activation of PCA on cultured human umbilical vein endothelial cells. Meanwhile, human umbilical cord serum elevated PCA more than either fetal bovine serum (FBS) or human adult serum. Generally, the existence of LPS raises the concentration of EGF in the blood, since monocytes and other types of cells express EGF and release it into the vessel by LPS stimulation. Although 10 ng/ml EGF did not induce PCA even in the presence of 10% FBS, it enhanced LPS-induced PCA under the same conditions. In the presence of 10% FBS, PCA induced both by LPS alone and by LPS + EGF was reduced the same amount by the protein kinase C (PKC) inhibitors H7 and H8. These results suggest that the serum contains some cofactor other than EGF, and that EGF enhanced this LPS-induced PCA independent of the cofactor through PKC-involved signaling.

Dynamics of intracellular granules with CD63-GFP in rat basophilic leukemia cells.

CD63 is located on the basophilic granule membranes in resting basophils, mast cells, and platelets, and is also located on the plasma membranes of the cells. We constructed a CD63-GFP (green fluorescent protein) plasmid and introduced it into rat basophilic leukemia (RBL-2H3) cells to observe the movements of CD63 on degranulation. The movements of CD63-GFP were studied in living RBL cells by confocal laser scanning microscopy (CLSM). CD63-GFP, in which GFP was conjugated to the C-terminus of CD63, was located on both the granule membranes and the plasma membranes of RBL cells. The diameter of the fluorescent granules in the cytoplasm varied from 0.5 to 1.5 microm. Before antigen stimulation most granules with CD63-GFP hardly moved in RBL cells. However, after antigen stimulation the plasma membranes ruffled violently and the granules moved dramatically. They reached the plasma membranes in a few minutes and fused with them instantaneously. Analysis of the movement of each granule provided a new insight into the elementary process of degranulation. The velocity of the granule movement toward the plasma membranes on antigen stimulation was calculated to be 0.1+/-0.02 microm/s. This shows that the granules are able to reach the plasma membranes in 2 or 3 min if the diameter of the cells is 20 microm.

High-resolution image reconstruction method for time-of-flight positron emission tomography.

We present a new image reconstruction method for time-of-flight positron emission tomography (TOF-PET). The TOF-PET measurement system is modelled using the continuous-discrete mapping model, and images are reconstructed using an algebraic technique. The proposed method can produce images with better spatial resolution than conventional methods based on the filtered backprojection method. Numerical simulation results show that accurate modelling of the measurement system improves the spatial resolution and the contrast recovery, while the utilization of TOF information improves the signal-to-noise ratios of images.

Comparison of sperm motility test methods (except computer-assisted sperm analysis) in rats under the condition of alfa-chlorohydrin treatment--collaborative investigation.

A comparison among rat sperm motility test methods including percent of motile sperm (% Motile), scoring method (Scoring), Ishii's method, Progressive Motility Test (PMT) and Sperm Quality Analyzer (SQA), was conducted using data gathered from eleven laboratories. As a unified study design, mature male rats were orally treated daily for approximately 1 week with alpha-chlorohydrin (ACH), which is known to affect the sperm motility at the epididymis, at dose levels of 2.5, 5 and 10 mg/kg, and then subjected to more than two test methods for sperm motility in each laboratory. Scoring (4 or 5 grades), Ishii's method, PMT and SQA showed high sensitivity for the detection of the effects of ACH, which were not considered to be inferior to a computer-assisted sperm analyzer (CASA). Longer incubation time before testing was considered to contribute to detecting the effects of ACH. In particular, we realized that Scoring was a favorable method even if the demerit of poor objectivity was allowed for. Percent Motile showed lower sensitivity than other test methods. The differences in sensitivity between % Motile and other methods were considered to be based on whether the defects of progressive motion could be detected. Although % Motile cannot clearly judge whether immotile sperm are dead or alive, the value is a great help for the interpretation of the result from other methods. Based on the characters for detectability, objectivity and efficiency, the most suitable method of sperm motility should be selected according to the purpose of the toxicity study.

Effects of phenylephrine and prazosin on axial movement of the rat incisor and arterial blood pressure.

We investigated the dose-response effects of phenylephrine and antagonistic effects of prazosin on axial movement of the rat incisor and arterial blood pressure. Phenylephrine caused a temporal extrusive tooth movement and an increase in blood pressure at all doses. With increasing phenylephrine doses, the maximum extrusive tooth movement and maximum increase in blood pressure were enhanced. The maximum extrusive tooth movement and increase in blood pressure induced by phenylephrine were markedly suppressed after pretreatment with prazosin. These results suggested that extrusive tooth movement is closely related to the rise in blood pressure due to stimulation of vascular alpha1-receptors.

The relation between degranulation and rapid metabolic responses in RBL-2H3 cells.

The relation between degranulation and rapid metabolic responses (acidification rate changes) in RBL-2H3 cells was studied using a cytosensor microphysiometer, a silicon-based biosensor system. The metabolic responses in RBL-2H3 cells by antigen stimulation were compared with those by inhibitors of Ca2+ -ATPase. The former resulted in a rapid transient increase in the acidification rate of RBL-2H3 cells while the latter resulted in gradual decreases. When RBL-2H3 cells were costimulated with the inhibitors of Ca2+ -ATPase and an activator (PMA, phorbol-12-myristoyl-13-acetate) of protein kinase C, the metabolic responses increased again in RBL-2H3 cells. This seems to indicate that degranulation in RBL-2H3 cells was accelerated by costimulation with the inhibitors and PMA. However, costimulation was not able to completely mimic the way antigen stimulated RBL-2H3 cells in degranulation and in rapid metabolic responses.

Sarcoma botryoides of the uterine cervix: a case report.

Rhabdomyosarcoma of the uterine cervix is a very rare disease. We present a case of rhabdomyosarcoma (botryoide type) arising from the introitus of the uterine cervix, and make a discussion on the diagnosis, treatment and involving factors of prognosis.

[Treatment of prostate cancer by radiotherapy].

Fifty-seven patients with clinically localized prostate cancer were treated by radical prostatectomy or external radiation therapy following pelvic lymphadenectomy. Comparing the outcome of radiotherapy with that of prostatectomy in 42 T2 patients without lymph node metastasis, the 5-year cause-specific survival did not differ between the radical prostatectomy group (n = 31) and radiotherapy group (n = 11). The 5-year disease-free survival of the prostatectomy group, however, was superior to that of radiotherapy group (p = 0.01). To cure patients with T2 prostate cancer, therefore, it is supposed that radical prostatectomy should be performed. To improve the treatment outcome after radiotherapy, stereotactic radiosurgery for prostate cancer has been attempted in our institution. Phantom experiments using a linear accelerator demonstrated a round dose distribution, and high reproducibility of prostate positioning was confirmed by CT when a thermoplastic immobilization device was used to fix the pelvis. In one patient with localized prostate cancer treated by radiosurgery, acute complication has not been recognized during the 5 week follow-up. Radiosurgery may be available to treat clinically localized prostate cancer.

A case of pigmented dermatofibrosarcoma protuberans (Bednar tumor).

The present paper reports a 67-year-old male with pigmented dermatofibrosarcoma protuberans (Bednar tumor) on his right shoulder. The lesion had recurred twice. Clinically, the lesion was a reddish-brown, exophytic, multilobular, firm nodule with an irregular surface, which measured 6.4 x 4.2 cm. Histologically, the proliferated fibroblasts showed a cartwheel pattern and stained positively with CD34, similar to those of a common dermatofibrosarcoma protuberance. However, many melanin-bearing cells that were positive for the S-100 protein were found intermingled among the tumor cells. Based on these findings, we concluded that the clinical manifestations, level of malignancy, and cytological features, as well as the exception of melanin-bearing dendritic cells associated with pigmented dermatofibrosarcoma protuberans, suggest a common dermatofibrosarcoma protuberans. This supports the hypothesis that pigmented dermatofibrosarcoma protuberans is a pigmented variant of dermatofibrosarcoma protuberans. Thus, this type of tumor is not benign, but is an intermediate malignant tumor.

Optical implementation of the stream cipher based on the irreversible cellular automata algorithm.

A hybrid optical scheme for efficient hardware implementation of the one-dimensional, three-neighborhood binary cellular automata rule a(i)(?) =a(i-1)XOR(a(i)OR a(i+1)) -based stream cipher is proposed. The system makes full use of the parallel, space-invariant, cascadable, and modular structure of the algorithm and is simple, robust, and compact. The number of cellular automata arrays can be as large as the number of pixels on the spatial light modulator, which results in an increase in speed (number of bits operated in parallel) and security (key length). The system can be made fully optical with the use of an optically addressable spatial light modulator for the input plane and for the nonlinear threshold element.

Change of embryotoxic susceptibility to di-n-butyltin dichloride in cultured rat embryos.

Di-n-butylin dichloride (DBTCl), which is commonly used as heat and light stabilizer for polyvinyl chloride (PVC) plastics, is a teratogen in vivo. In the present study, the toxic effects were investigated of DBTCl on cultured rat embryos during three different stages of organogenesis. Rat embryos explanted on gestational day (GD) 8.5, GD 9.5, and GD 11.5 were cultured for 68, 46, and 48 h and were exposed to a range of DBTCl concentrations for the first 24, 46, and the last 46 h of culture, respectively. Significant decreases in the placental diameter at > or = 10 ng/ml and in the number of somite pairs and the morphological score at 30 ng/ml were noted in embryos cultured from GD 8.5. Significant decreases in the yolk sac diameter and the crown-rump length at 100 ng/ml, in the number of somite pairs at > or = 50 ng/ml, and in the morphological score at > or = 30 ng/ml were found in embryos cultured from GD 9.5. No adverse effects on these parameters were detected in embryos cultured from GD 11.5 even at 300 ng/ml. Dysmorphogenesis in embryos cultured from GD 8.5, GD 9.5, and GD 11.5 was observed at > or = 10, > or = 50, and 300 ng/ml, respectively. Incomplete turning and craniofacial defects in embryos cultured from GD 8.5 and GD 9.5 and defects of the forelimb buds and tail in embryos cultured from GD 11.5 were frequently observed. These results show that in vitro exposure to DBTCl interferes with normal development of embryos during three different stages of organogenesis and that susceptibility to the embryotoxicity, including the dysmorphogenic potential of DBTCl, varies with developmental stage.

IS&C (Image Save & Carry) standard: standardized exchange media for medical information.

There has been a strong need for a standardized medical image exchange media. MEDIS-DC in Japan created IS&C as a standard for this purpose, based on 5.25' rewritable magneto-optic discs, with many specifications such as fast speed read/write, independence of apparatus vendor, additional security features, and data format compatible to ACR-NEMA v.2 image format. IS&C is already applied to many institutions, as an alternative for fast expensive networks, long term image casebases and media for teaching file distribution. The IS&C committee hopes this standard will be: 1) used at clinics and hospitals, promoting exchange of information between them, 2) harmonized with other standardization activities, and 3) a basis for future electronic semantic medical records.

Small hepatocellular carcinoma: treatment with US-guided intratumoral injection of acetic acid.

PURPOSE: To assess the efficacy of ultrasound-guided percutaneous acetic acid injection (PAI) in the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Results of a preliminary study in rats showed that the effectiveness of acetic acid in the destruction of hepatocytes plateaued at a concentration of 50%. Thus, PAI with 50% acetic acid was performed in 25 patients with solitary HCCs 3 cm or less in diameter. The viability of tumor cells after PAI was examined by means of contrast material-enhanced computed tomography (CT) and fine-needle biopsy in all patients. Two patients underwent partial hepatic resection. RESULTS: No clinically significant complications occurred in 82 treatment sessions. All lesions became smaller after a mean of 23 months +/- 8 (standard deviation) of follow-up. There was no evidence of viable HCC at follow-up biopsy and CT. Two HCCs obtained by means of resection showed complete necrosis. The 1-year survival rate among 23 patients who did not undergo surgical treatment was 100%; the 2-year survival rate was 92%. CONCLUSION: PAI may prove to be an effective therapy for small HCC.

Multiple current dipole estimation using simulated annealing.

A method for estimating electrical current distribution in the human brain using a multiple current dipole model is presented. A cost function for estimating multiple dipoles is proposed and a simulated annealing algorithm is used to obtain an acceptable solution. Computer simulation is used to evaluate the effectiveness of this method.

In vitro study of teratogenic effects of caffeine on cultured rat embryos and embryonic cells.

The teratogenic potential of caffeine was examined in vitro by a whole embryo culture system (WECS) and an embryonic cell culture system (micromas teratogen assay: MTA) in the rat. In the WECS, hyperemia of the tail, and a reduction of the placental size was induced by caffeine at concentrations higher than 50 micrograms/ml; hypoplasia of the forelimb bud was induced at concentrations higher than 100 micrograms/ml; hematoma in the yolk sac and dysmorphogenesis of the fore- and hind-limb buds, prosencephalon and tail were induced by 200 micrograms/ml caffeine. In the MTA, even with 200 micrograms/ml caffeine, the toxicological parameters obtained by proliferation and differentiation assays of the midbrain and limb bud cells were almost the same as in the control. In conclusion, caffeine induced various morphological anomalies, but did not affect proliferation or differentiation of cells in these experimental systems.

IS & C system and file protection mechanism.

This paper reports a new extension of IS & C (Image Save And Carry) project. Because IS & C is an off-line system and requires full compatibility so as to enable medical data interchange with ease among hospitals and clinics, specifications that are indispensable for compatibility have been standardized by the IS & C committee. The IS & C system is supposed to be used in medicine, so the file protection mechanism for the security of the recorded files has been also developed. The characteristics of IS & C volume and file structure and the second national project being carried out in National Cancer Center Hospital are briefly explained as well.

Standards of medical informatics in Japan.

Standardization activities related to medical informatics in Japan are briefly introduced in this paper. Because two kinds of portable media that are MODs (Magneto Optical Disk) and IC cards are supposed to be practically used in medicine, standardization works are currently supported by Japanese government. With an introduction of the organizations their standards and policy are explained.

[Effect of coagulation inhibitor proteins (Calphobindins) on tissue factor expression of endothelial cells].

We established a method for measuring procoagulant action on human umbilical vein endothelial cells (HUVEC). HUVEC (2.5 x 10(4)/well) were stimulated with 1 microgram/ml endotoxin (lipopolysaccharide: LPS) for 6 hours at 37 degrees C in 5% CO2. After washing, the HUVEC were incubated with assay buffer containing Proplex ST 1 unit (factor VII)/ml, S2222 0.6 mg/ml and CaCl2 6.6 mM, for 30 minutes at 37 degrees C. The procoagulant activity was determined by measuring the supernatant at OD405. Calphobindin I, II and III (CPB I, CPB II and CPB III) are the calcium dependent phospholipid binding proteins that exhibit anticoagulant activity in vitro. In this study, we investigated the effects of CPB I, CPB II and CPB III on procoagulant activity (PCA) expressed on HUVEC. The results are as follows 1) CPBI inhibits the procoagulant activity on HUVEC in a dose-dependent manner (IC 50% less than 0.4 microM). The same doses (0.4 microM) of CPBII and CPBIII decreased the procoagulant activity to 28.1% (CPBII), and to 84.6% (CPB III). CPB anticoagulant activities were, CPBII greater than CPBI greater than CPBIII, in that order. 2) When 0.05% H2O2 was added to the cell culture medium wells, concentrations of CPBI in supernatants increased in a time-dependent manner, and they reached to the maximum after 8 hours. CPBI in supernatants after 24 hours were not detected without H2O2, but concentrations of 4.88 ng/ml/10(4) cells with 0.01% H2O2, and 9.60 ng/ml/10(4) cells with 0.05% H2O2 were detected.