[Renal cell carcinoma extending into the right atrium; report of a case].

A 62-year-old male was diagnosed through abdominal ultrasonography, with right renal cell carcinoma extending into the inferior vena cava. Surgery was performed because echocardiography revealed the tumor to have reached the right atrium. The portion of the tumor situated in the right atrium was resected under the extracorporeal circulation. Distal part of inferior vena cava was resected with the tumor included. The tumor remaining in the confluence of hepatic veins was removed from the incised end of the inferior vena cava and was detached from the venous wall. Postoperative abdominal echography revealed a small additional tumor mass in hepatic veins. Although this mass was considered to be a remnant of the intravenous tumor, an additional surgical procedure was judged to be impossible. In retrospect, an additional long-axis incision on the inferior vena cava might have enabled us to catch the remnant of the tumor thrombus in the hepatic vein.

The evaluation of autonomic nervous function in a patient with hereditary sensory and autonomic neuropathy type IV with novel mutations of the TRKA gene.

We report on a 10-year-old girl with anhidrosis and insensibility to pain, but no severe mental retardation or self-mutilation, diagnosed as hereditary sensory and autonomic neuropathy type IV (HSAN IV). Genetic analysis of her TRKA gene, which is responsible for HSAN IV, revealed two novel missense mutations in the tyrosine kinase domain. Cardiovascular autonomic nervous system function tests showed normal muscle sympathetic nerve activity associated with arterial baroreflex, reduced skin sympathetic nerve activity in the second and fifth fingers and palms, and abnormal circadian rhythm of cardiovascular autonomic nervous system. These findings have never before been reported in HSAN IV and may provide a clue to the neurological pathophysiology of this disease.

Sensor system using polarization analysis method to monitor oil-on-water in water purification plants and rivers.

Some 80% of accidental pollution in river water is caused by oil spills. Oil spills can cause serious damage such as suspension of water intake at water purification plants and major harm to ecosystems in the lower reaches of rivers. This is because oil-on-water tends to spread easily, quickly exacerbating the damage. To address this problem, an automated, continuous sensor system with high sensitivity can be used for early detection of spill accidents. We have developed a sensor system for detecting oil-on-water based on a polarization analysis method. Its advantages include: a) no direct contact with sample water; b) minimal maintenance; c) largely unaffected by foreign matter and waves on the water surface; and d) much higher sensitivity than simple visual observation. This paper describes the measurement principle and configuration of the sensor system, and discusses the results of sensitivity tests and tests on the influence of water turbidity, foreign matter and waves. We will also consider some of the limitations of the new system.

[Regional variation in bone mineral density and motor function in children with cerebral palsy].

Bone mineral density (BMD) and motor activity of the upper extremities, were studied in 18 children with spastic cerebral palsy (CP group) and 12 age-matched normal boys (control group). The motor activity was monitored by a piezoelectric transducer. Whole body BMD as well as BMD of the head, upper limbs, ribs, spine, pelvis, and lower limbs was evaluated by dual energy x-ray absorptiometry. In the CP group, BMDs were lower compared to control group in the whole body and in all the body regions (except for the head) especially in the pelvis and lower limbs. BMDs of these regions were higher in walking patients than in bed-ridden, rolling, and crawling patients. Motor activities in the upper extremities were lower in the CP than in the control group. BMD increased with developing motor activity in the upper extremities. These results implicate diminished BMDs of the lower limbs and pelvis, which are associated with standing and walking, to the high incidence of femur fractures in CP.

The influence of controlled occlusal overload on peri-implant tissue. Part 3: A histologic study in monkeys.

The influence of experimental occlusal overload on peri-implantitis in monkeys (Macaca fascicularis) has been examined to explain the pathology of the disease that develops in the tissue around osseointegrated implants. In the first article of this series, it was reported that bone resorption was not observed around implants when occlusal trauma was produced by a super-structure that was in supraocclusal contact with an excess occlusal height of approximately 100 microns, provided there was no inflammation in the peri-implant tissue. In the second part of the study, experimental inflammation was created in the peri-implant tissue, and occlusal overload was produced by a superstructure with an excess occlusal height of 100 microns. Notable bone resorption was observed around the implant with the passage of time. These results suggested that, in addition to the control of inflammation in peri-implant tissue, traumatic occlusion may play a role in bone breakdown around the implant. In the present study, while the peri-implant tissue was kept in an inflammation-free state, bone level changes around the implants were investigated when various levels of traumatic force were exerted. The supraoccluding prostheses were defined as excessively high by 100 microns, 180 microns, and 250 microns, respectively. The heights were determined with an image analysis device, and the bone responses around the implants induced by the traumatic forces were investigated. The results showed that bone resorption around implants tended to increase with 180 microns or more excessive height of the superstructure. This suggests that the threshold of excessive height of the superstructures at which peri-implant tissue breakdown may start is approximately 180 microns. It is also suggested that there is a possibility of bone resorption around the implants caused by excess occlusal trauma, even when there is no inflammation in peri-implant tissue.

Evaluation of leukocyte-reducing arterial line filter (LG6) for postoperative lung function, using cardiopulmonary bypass.

OBJECTIVE: To prevent postoperative pulmonary dysfunction, we have investigated the effect of the Leuko-Guard 6 leukocyte-reducing arterial line filter (LG6) on postoperative lung function. METHODS: Twenty-six cases of adult valvular heart disease were included in this study. Thirteen cases were operated upon using the LG6 (Group LG), and 13 cases were operated upon using a conventional arterial line filter (Group C). Neutrophil, polymorphonuclear leukocyte elastase and lipoperoxide were measured for this study, and the lung function was evaluated using the Oxygenation Index (PaO2/FiO2). RESULTS: Statistically significant differences were observed in neutrophil counts between Group LG and Group C (LG = 2225 +/- 572/mm3, C = 3157 +/- 1413/mm3, p = 0.04) at 5 minutes after the onset of cardiopulmonary bypass. In simultaneous blood sampling from the pulmonary artery and the pulmonary vein, the sequestration of neutrophil in the lung decreased in Group LG after the discontinuation of cardiopulmonary bypass. Release of polymorphonuclear leukocyte elastase from the lungs was significantly decreased (p = 0.04) in the Group LG at 1 hour post-bypass. Significant differences were observed in the Oxygenation Index between Group LG and Group C (LG = 398 +/- 72, C = 326 +/- 71, p = 0.019) at 3 hours post-bypass. CONCLUSION: We concluded that LG6 improved the postoperative lung function, and its mechanism might be derived from the prevention of leukosequestration in the lungs that occurs during the rewarming phase due to selective absorption of activated leukocyte by the LG6.

Significant evidence for linkage of febrile seizures to chromosome 5q14-q15.

Febrile seizures (FSs) represent the most common form of childhood seizure. In the Japanese population, the incidence rate is as high as 7%. It has been recognized that there is a significant genetic component for susceptibility to this type of seizure. Two putative FS loci, FEB1 (chromosome 8q13-q21) and FEB2 (chromosome 19p), have been mapped. Furthermore, a mutation in the voltage-gated sodium (Na(+))-channel beta1 subunit gene ( SCN1B ) at chromosome 19q13.1 was identified in a family with a clinical subset, termed generalized epilepsy with febrile seizures plus (GEFS(+)). These loci are linked to some large families. In this study, we conducted a genome-wide linkage search for FS in one large family with subsequent linkage confirmation in 39 nuclear families. Significant linkage was found at D5S644 by multipoint non-parametric analysis using GENEHUNTER ( P = 5.4 x 10(-6)). Estimated lambda(s)at D5S644 was 2.5 according to maximum likelihood analysis. Significant linkage disequilibria with FS were observed at the markers D5S644, D5S652 and D5S2079 in 47 families by transmission disequilibrium tests. These findings indicate that there is a gene on chromosome 5q14-q15 that confers susceptibility to FSs and we call this gene FEB4.

Estimation of bacterial contamination in ultrapure water: application of the anti-DNA antibody.

We constructed and established a hybridoma cell line that produces immunoglobulin G-type anti-DNA antibody. By using this antibody, we could successfully detect a single bacterial cell in ultrapure water (UPW). The detection system is composed of a membrane-supported western blotting-type immunoassay and a two-dimensional photon analyzer with high resolution. It can detect and count every bacterial cell in a wide field of view on a trapping filter i.e., a circle with an 18-mm diameter. This means 10 fg (10(-14) g) of bacterial DNA can be detected in the field. This system could be a useful tool for evaluating the number of bacteria contained by UPW and water used for medical purposes.

[A case of coronary artery bypass surgery using left internal thoracic artery and right gastroepiploic artery for a patient with essential thrombocythemia].

The 78-year-old male underwent coronary angiography because of angina pectoris. He was revealed to have essential thrombocythemia with a platelet count of over 1,000,000/mm3. Essential thrombocythemia belongs to the group of chronic myeloproliferative disorders. It displays both thrombogenic and bleeding tendency due to the increased platelet count, as well as to dysfunction. CABG was performed using the left internal thoracic artery and the right gastroepiploic artery. Hydroxycarbamide was taken to regulate the platelet count before surgery. There was no difficulty with hemostasis during surgery. Warfarin and hydroxycarbamide were used as anticoagulant therapies after surgery. Postoperative CAG demonstrated both grafts to be patients. The patient remained in good condition until he died suddenly on the 159th postoperative day. The cause of death was not clear because no autopsy was carried out. The death may have been associated with a thromboembolism, acute graft thrombosis or cerebral infarction, or pulmonary embolism. This patient did not take antiplatelet drugs because the platelet count and prothrombin time was well controlled. Nonetheless, an antiplatelet agent might reduce the risk of thromboembolism in such patients. It is suggested that meticulous anticoagulation therapy must be important for a patient with essential thrombocythemia, especially in the postoperative period.

A quantitative study of the progress of myelination in the rat central nervous system, using the immunohistochemical method for proteolipid protein.

The temporal changes in intensity of myelination of the nervous pathways in 0 to 42-day-old Wistar rats were quantitatively analyzed by immunohistochemistry with anti-proteolipid protein and compared with that obtained by immunohistochemistry with anti-myelin basic protein. Immunohistochemistry was performed on paraffin-embedded tissue according to the standard ABC technique. Intensity of myelination was examined by an image analyzing system. We analyzed nine nervous pathways: corpus callosum, optic tract, internal capsule, spinal tract of the trigeminal nerve, inferior cerebellar peduncle, cerebellar white matter, pyramidal tract, medial longitudinal fasciculus, and cuneate fasciculus. The presence of immunoreactive fibers for proteolipid protein (PLP) in the spinal tract of the trigeminal nerve, medial longitudinal fasciculus and cuneate fasciculus was noted on postnatal day 0. Those of the corpus callosum, inferior cerebellar peduncle, cerebellar white matter, pyramidal tract and internal capsule were noted on day 7, and that of optic tract on day 14. The time required to reach the intensity of myelination of day 42 was day 14 for the cuneate fasciculus, day 21 for the spinal tract of the trigeminal nerve, inferior cerebellar peduncle and medial longitudinal fasciculus, day 28 for the optic and pyramidal tracts, day 35 for the corpus callosum and day 42 for the internal capsule and cerebellar white matter. The appearance of immunoreactive fibers for PLP was usually earlier than that for myelin basic protein (MBP) and the pattern of difference between PLP and MBP can be classified into three groups: (1) their time of appearance and progress are almost the same, as in the optic tract; (2) the appearance and progress of PLP occurs earlier than those of MBP, as in the pyramidal tract; (3) the appearance of PLP occurs earlier than that of MBP, but their progress is the same. Our findings revealed that the time of appearance and progress of myelination as measured by PLP are different among the nervous pathways, and that there is also a difference between PLP and MBP. This difference between PLP and MBP may indicate a functional difference between them.

[Long-term results of aortic root replacements with pulmonary autografts (Ross procedure) in five cases].

Aortic root replacement with a pulmonary autograft (the Ross Procedure) has been successfully performed in our hospital since November, 1992. The long-term results of five of the earliest cases are reported in this paper (2-3 year follow-up). The patients' ages were two months to eighteen years old. Four of the patients suffered from aortic valve stenosis, and one suffered from aortic regurgitation. Severe left ventricular failure was recognized in three cases. However, the patients recovered from surgery smoothly and without significant aortic regurgitation and left ventricular outflow tract gradients. A serious concern exist as to whether the implanted autograft in 2 months old infant would grow. In this patient, postoperative cardiac catheterization was performed after sixty days, one year, and two years. The diameter of the anulus of the pulmonary autograft enlarged from 12 mm to 18 mm over the period of two years. Compared with the calculated aortic valvular diameter from a standardized body surface area, these diameters were equivalent to 150%-162% of the standardized size at each age. The implanted pulmonary autograft has subsequently enlarged gradually and proportionally. Its function as an aortic valve was maintained even after significant enlargement of the aortic anulus to 18 mm. We therefore conclude that the Ross procedure can be recommended because of the apparent ability the pulmonary autograft to grow over time.

[Monitoring of electroencephalogram during the operation under the extracorporeal circulation].

Generally speaking, it is difficult to know the occurrence of brain complication until the patient becomes awake from anesthesia. But if we can detect the occurrence of of brain complication during the operation, we can start its therapy even during the operation. In order to detect the occurrence of brain complication during the operation under extracorporeal circulation (ECC), we monitored intraoperative electroencephalogram (EEG). Since June 1992, forty-two patients were operated on using ECC. Usual ECC was applied in 39 cases (Group-A), and circulatory arrest with retrograde cerebral perfusion was applied in remaining three cases (Group-B). We studied the amplitude of EEG using actual value (by Fujimori method), and compressed EEG acquired by slow-paper-feed recording. In terms of the frequency of EEG, we studied compressed spectral array (CSA). In Group-A, there was no brain complication identified after operation. Actual values of amplitude were 23 +/- 4.0 microV (before ECC), 19 +/- 4.0 microV (during ECC), 23 +/- 4.9 microV (after ECC). There was a significant decrease (p < 0.001) of amplitude during ECC compared with that before ECC. The ratio of amplitude during ECC to that before ECC (D/B ratio) was 0.82 +/- 0.16. The ratio of amplitude after ECC to that before ECC (A/B ratio) was 1.01 +/- 0.15. According to compressed EEG, it was observed that the amplitude changes following the up-down of esophageal temperature. In CSA, influence of esophageal temperature on the power spectrum of alpha and delta wave band was recognized. In Group-B, there was one brain complication identified after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of Behçet's disease associated with ascending aortitis and aortic regurgitations--surgical repair with Cabrol's method].

This is the case report of a 52 years old female patient operated with Cabrol's method for the inflammatory lesion of the aortic root in Behçet's disease. The diagnosis of incomplete type of Behçet's disease had already been established 4 years ago and the patient had been taking regular check-up since then. About one year ago, newly developed cardiac murmur compatible with aortic regurgitation was detected and the patient was subsequently referred to us for the surgical repair. Although aortic valve replacement (AVR) was attempted first, Cabrol's method was lastly chosen, since inflammatory features on the surface of the ascending aorta associated with slight aortic annular dilatation were observed during the procedure and it was easily anticipated that these might induce postoperative paravalvular leakage and pseudoaneurysm, if AVR were performed. Two weeks after the surgery, the patient developed aphthous stomatitis associated with several other evidences of inflammatory recurrence, the steroid therapy was instituted with prednisolone. Post operative progress was uneventful and the patient has been completely well at the 6th month after the surgery. In conclusion, it is strongly recommended the Cabrol's method should be chosen to prevent post operative unfavourable complications, whenever any evidence of inflammation is observed around the aortic root area.

[Two separate surgical repairs of post-infarction blowout rupture of the left ventricular free wall and subsequently developed subepicardial aneurysm].

A 69-year-old female patient with acute myocardial infarction was admitted to our hospital. After i.v. administration of the rt-PA, echocardiography disclosed pericardial effusion to which pericardial drainage was performed first through subxiphoid incision. Immediately after the drainage, electromechanical dissociation emerged and emergency thoracotomy was performed. There was a small blowout rupture of the left ventricular free wall that was successfully repaired using single suture buttressed with Dacron felt without cardiopulmonary bypass support. On the 38th day after the surgery, cineangiography disclosed ventricular aneurysm, to which aneurysmectomy was performed under the cardiopulmonary bypass and her post operative progress was uneventful. Histological study of the resected specimen revealed so called subepicardial aneurysm. Although blowout rupture of the left ventricular free wall used to be lethal, there might be a chance of life saving even without cardiopulmonary bypass support, if the left thoracotomy could be done as quickly as possible.

Restoration of cytogenetically normal marrow cells after remission of lymphoblastic crisis in a case of Ph positive CML treated with alpha-interferon.

A patient with Philadelphia (Ph) chromosome-positive chronic myelogenous leukemia (CML) who was treated with alpha-interferon (alpha-IFN) is reported. After the treatment, the number of Ph+ bone marrow (BM) cells decreased gradually and the intensity of the rearranged major breakpoint cluster region (M-BCR) gene became faint; however, a lymphoblastic crisis developed about 1 year later. At the time of the blast crisis, the rearranged M-BCR band was detected, indicating that the blast crisis clone was derived from CML cells. The patient was treated with a combination of vincristine, prednisolone, daunorubicin, and L-asparaginase, and a hematologic remission was obtained. During the remission status, no rearranged M-BCR fragment was detected by conventional Southern analysis. Thus, the hematologic and genetic alteration in this case appeared to be identical to Ph+ acute leukemia with M-BCR rearrangement. The current case therefore indicates that alpha-IFN can reduce the proportion of Ph+ cells, but is unable to prevent blast crisis. Furthermore, the quantitative reduction of the cell population with a Ph chromosome may have some effects in modifying the genetic manifestations and clinical features of Ph+ CML, e.g., the delay in the appearance of the blast crisis.