Influence of hypertension on pH of saliva in older adults.

BACKGROUND: Hypertension and/or antihypertensive medication reportedly induce dry mouth; however, an immediate relationship between salivary flow and hypertension has not been elucidated. OBJECTIVES: The purpose of the present study was to examine the association of hypertension and antihypertensive medication with salivary flow rate and pH in older adults. SUBJECTS: Subjects were independently living volunteers aged 60-78 years taking no medication (n = 138) or only antihypertensive medication (n = 27). Unstimulated saliva and stimulated saliva by the mastication method were collected, and salivary pH was measured. Hypertension was defined as systolic blood pressure of ≥ 140 mmHg and/or diastolic blood pressure of ≥ 90 mmHg. RESULTS: There was no significant correlation between either hypertension or intake of antihypertensive medication and unstimulated or stimulated salivary flow rate. However, multiple regression analysis showed that hypertension was significantly associated with pH of unstimulated saliva after controlling for other variables (ß = -0.270, P = 0.003). CONCLUSION: Hypertension regardless of antihypertensive medication was related to a lower pH of unstimulated saliva. Blood pressure might be a required consideration for maintenance of oral health in older individuals.

Subjective values of different treatments for missing molars in older Japanese.

The purpose of this study was to determine how elderly Japanese people subjectively value treatment options for missing molars. Subjects were 528 independently community-dwelling elderly people. They were presented with photographs and descriptions of the process and expected outcomes of five possible treatment options: cantilever fixed dental prosthesis (FDP); resin or metal removable partial denture prosthesis (RPDP); implant-supported fixed prosthesis; and no replacement (shortened dental arch: SDA) for missing lower bilateral first and second molars. The participants filled in the questionnaire on subjective importance for treatment and indicated on a visual analogue scale how they valued the treatment (utility value: UV). Values were analysed by Mann-Whitney U-tests and multiple logistic regression analyses. Overall, the UVs for the FDP and the metal RPDP were the highest, and the UV for the SDA was the lowest. With respect to subjective importance, 'chewing ability' and 'no pain during function' were significantly selected more frequently. Multiple logistic regression analyses showed that the UV for the resin RPDP had significant positive associations with denture wearers and low treatment cost, whereas the implant had significant negative associations with denture wearers and older age. The SDA had significant positive associations with men and low treatment cost and a negative association with appearance. In conclusion, these elderly Japanese preferred cantilever FDPs and metal RPDPs to implants and 'no replacement.' It suggests that the SDA as an oral health goal can be questionable from the patients' point of view, even if it is biologically correct.

Diagnostic implications of MR imaging for mucinous adenocarcinoma arising from fistula in ano.

Mucinous adenocarcinoma associated with chronic fistula in ano is rare, and diagnosis is often difficult. Two cases of mucinous adenocarcinoma arising from fistula in ano occur in a patient with longlasting fistulas, persisting for more than 10 years, are presented. In two cases, T2-weighted MR images revealed symptomatic features; that is, the hyperintense heterogeneous content looked like a gathering of various sizes of granules. This is due to the fact that mucinous adenocarcinomas usually consist of the gathering of many small mucous lakes. This finding has the implications in diagnosing mucinous adenocarcinoma arising from carcinoma in ano.

An incidentally discovered small and asymptomatic para-aortic paraganglioma.

Preoperative diagnosis of asymptomatic paraganglioma is difficult due to the lack of specific symptoms. In this report, we present a rare case of a small and asymptomatic para-aortic paraganglioma. A 34-year-old woman who complained of back pain was admitted for further examination. No abnormal findings were observed on physical or laboratory examinations. An abdominal CT scan and an abdominal MRI incidentally noted a mass about 3 cm in diameter adjacent to the right edge of the inferior vena cava. The following aortic angiography showed the tumor with a feeding artery diverting directly from the aorta. The tumor was completely resected by laparotomy. The resected tumor, 3 x 3 x 3 cm in size, was soft, dark-reddish and encapsulated. Immunohistochemical examinations showed that it was positive for neuron-specific enolase, chromogranin A and adrenocorticotropin. Under these findings, the diagnosis of para-aortic paraganglioma was determined. Seven years after the operation, she remains asymptomatic and free of disease.

A prolongation of hepatic vascular exclusion by in situ hypothermic perfusion in dogs.

In situ hypothermic hepatic perfusion was performed in dogs to explore whether the time limit of hepatic vascular exclusion could be prolonged. During hepatic vascular exclusion, hepatic hypothermic perfusion was performed via portal vein using various perfusates under active bypass from the portal vein and infrahepatic inferior vena cava area to the superior vena cava system. Dogs receiving hepatic hypothermic perfusion for 1 hour died when given Ringer's solution but survived more than 7 days when given Euro-Collins' and University of Wisconsin solutions. Although dogs tolerated 2 hours of hepatic hypothermic perfusion when give University of Wisconsin solution, all dogs died by 2 hours of hepatic hypothermic perfusion when given Euro-Collins' solution. The hepatic energy charge and arterial ketone body ratio of dogs that died were significantly lower than for those that survived. This suggests that the regimen of hepatic hypothermic perfusion with University of Wisconsin solution is able to maintain the energy metabolism of the liver under hepatic vascular exclusion for prolonged periods, hence, its possible clinical application.

The effects of ice on blood flow and bone metabolism in knees.

The effects of an ice wrap, applied to a knee for 20 minutes, on blood flow and bone metabolism were measured using triple-phase technetium bone scans. Twenty-one subjects between 29 and 63 years of age were studied. A commercially available ice wrap was applied to one knee 20 minutes before scanning, while an identical wrap left at room temperature was applied to the opposite knee to act as a control. Scans of the knees were obtained at the completion of cooling, and the images were quantified by computer image analysis for each knee at each phase of the scan. Percentage of decrease in blood flow and subsequent bone uptake of technetium for the iced knee as compared with the opposite knee were calculated. All iced knees demonstrated decreased arterial and soft tissue blood flow as well as decreased bone uptake, which is a reflection of changes in both bone blood flow and metabolism. The average decrease was 38.4% +/- 4.97 in arterial blood flow, 25.8% +/- 2.04 in soft tissue blood flow, and 19.3% +/- 2.0 (standard error of the mean in each) in bone uptake. This "ice effect" was not related to age, sex, knee circumference, or skin temperature after cooling. By decreasing blood flow and cell metabolism, ice theoretically can limit hemorrhage and cell death in the setting of acute traumatic injury. This study thus provides a scientific rationale for the use of ice as tested for such injuries to a large joint, whether in the soft tissues or bones.

Arteriovenous malformation at the cervicomedullary junction: a case report with magnetic resonance imaging.

A rare case of arteriovenous malformation at the cervicomedullary junction is reported. A 72-year-old man developed symptoms of total transection of the upper cervical cord without evidence of subarachnoid hemorrhage. The arteriovenous malformation had an intramedullary nidus with an aneurysmal dilatation at the C-1 level. This lesion was diagnosed by magnetic resonance imaging and confirmed at autopsy. The neurological symptoms may have been due to compression of the spinal cord by the intramedullary lesion, followed by degeneration and necrosis. The usefulness of magnetic resonance imaging in the neuroradiological diagnosis is particularly emphasized.

Traumatic dissection of the common carotid artery after blunt injury to the neck.

BACKGROUND: Occlusive lesions of the common carotid artery (CCA) resulting from blunt injury are extremely rare, and their clinicopathologic and therapeutic features have not yet been clarified. OBJECTIVES AND RESULTS: Five patients with occlusive lesions of the CCA developed neurologic deficits at 1.5 hours to 10 years after blunt neck injury. Lesions included two complete occlusions, one severe stenosis, and two segmental intimal dissections of the CCA. In the two patients with CCA occlusion, bypass surgery was performed using a Dacron graft between the ipsilateral subclavian artery and the carotid bifurcation. In the remaining three patients, the involved segments were replaced with a Dacron graft. Surgical specimens from the early posttraumatic period revealed intimal tears with mural thrombosis and/or subintimal hematomas and those from the later period showed myointimal hyperplasia or fibrotic organization. CONCLUSION: Traumatic occlusive lesions of the CCA tend to evolve from intimal dissections to severe stenoses or occlusion, compromising cerebral circulation. The involved CCA can be diagnosed early by B-mode Doppler sonography and successfully reconstructed using a Dacron graft.

B-mode ultrasonographic investigations of morphological changes in endarterectomized carotid artery.

BACKGROUND: The aim of this study was to assess morphological changes in the endarterectomized carotid region using B-mode ultrasonography (USG). METHODS: USG examinations were performed on 54 Japanese patients who underwent carotid endarterectomy (CEA). The endarterectomized regions were periodically investigated and the intima-media thickness (IMT) was measured. RESULTS: Postoperative USGs revealed an evident step formation (type I: 20.4%), a gentle slope (type II: 42.6%), or complete smoothness (type III: 37.0%) at the junction of the endarterectomized carotid region and the common carotid artery (CCA). The IMT of the CCA progressively increased from type I to type III. Patients were followed up for an average of 2.7 years. The new intima-media complex (IMC) was confirmed in all cases after 9 months; it was visualized as an isoechoic layer (7%) or a mixture of iso- and hypoechoic layers (93%). Changes in the IMT during the follow-up period were classified into three groups: no change (group I: 23.1%), decrease (group II: 15.4%), and increase (group III: 61.5%). CONCLUSIONS: USG is useful to clarify the complicated healing processes of the endarterectomized carotid artery.

Magnetic resonance angiography visualization of four vessel (bilateral carotid and vertebral artery) occlusion--two case reports.

A 44-year-old female with transient vertigo and a 51-year-old female with headache and numbness of the hand presented with four vessel occlusion of the cerebral arteries (bilateral internal carotid arteries and bilateral vertebral arteries). This is an extremely rare entity, and the clinicoradiological features are not well documented. Magnetic resonance (MR) angiography visualized the cerebral arterial occlusion. Conventional angiography confirmed the diagnosis and demonstrated extensive collateral vessels. MR angiography is a useful method for screening patients with minimal or no symptoms for abnormalities in the cerebral circulation.

Neuroimaging findings of the development and resolution of solitary brainstem abscess: characteristics of neuroimagings in the early stage of brainstem abscess and importance of surgical management for brainstem abscess--case report.

A 64-year-old female presented with a solitary brainstem abscess. Magnetic resonance imaging and computed tomography demonstrated the development and resolution of the brainstem abscess with an unusual and fluctuating clinical course over several months. Serial neuroimaging examinations are required to detect a brainstem abscess in the early stage to establish the optimum treatment.

Cylindrical or T-shaped silicone rubber stents for microanastomosis--technical note.

The ostium of the recipient artery and the orifice of the donor artery must be clearly visualized for the establishment of microvascular anastomosis. Specially designed colored flexible cylindrical or T-shaped silicone rubber stents were made in various sizes (400 or 500 microns diameter and 5 mm length) and applied to bypass surgery in patients with occlusive cerebrovascular disease such as moyamoya disease and internal carotid artery occlusion. The colored flexible stents facilitated confirmation of the ostium of the artery even in patients with moyamoya disease and allowed precise microvascular anastomosis without problems caused by the stent.

[A case of subdural effusion secondary to dural metastasis of prostatic cancer: case report].

The authors reported a case of subdural effusion secondary to dural metastasis of prostatic cancer. A 61-year-old man was referred for headache, vomiting and gait disturbance. He had undergone hormonal therapy for prostatic cancer. He showed a mild left hemiparesis and anemia without bleeding. CT-scan disclosed a multilobular crescent shaped low density area in the right hemisphere. Under the diagnosis of chronic subdural hematoma, burr hole irrigation therapy was performed. Xanthochromic fluid was evacuated from the subdural space, in which no tumor cells were shown to exist. CT-scan on the 21st day disclosed a low density area, which was diagnosed as recurrent chronic subdural effusion. Therefore, craniotomy was performed to evacuate the subdural fluid and to explore the dura mater. Removal of the red hemorrhagic tumor at the dura mater and the fluid was performed. The patient died of heart failure in the 16th month despite complete recovery after the second operation. Histopathological examination of the tumor revealed adenocarcinoma at the outer part of the dura mater and the adjacent skull bone, where capillaries were embolized with tumor cells. However, no tumor cells were found in the subdural fluid. The authors could find in the literature 30 cases of subdural hematoma or effusion secondary to dural metastasis of carcinoma. The pathogenesis of the subdural hematoma in this case might be due to circulatory disturbance at the dura mater brought about by the invasion of the tumor or tumor cells emboli in the capillaries.

[Primary interhemispheric subdural abscess: report of a case].

We reported a rare case of primary interhemispheric subdural abscess. Twenty-three cases of this pathological condition have been reviewed. In those reports, however, findings of magnetic resonance imaging (MRI) were not referred to. In this report, MRI findings in this pathological condition, in addition to X-ray computed tomography (CT), is mentioned. A 22-year-old man, who had suffered from headache and vomiting for 2 weeks, suddenly became drowsy and left-hemiparetic. The X-ray CT scan on admission showed a well-circumscribed low density area in contact with the falx in the right parieto-occipital region. This lesion had so called "ring enhancement". MRI in the sagittal view revealed that, along the falx, the long T1 and T2 areas extended from the right cerebellar tentorium to the right frontal region. The operation demonstrated the capsular formation of the abscess. After pus aspiration, continuous drainage was performed from the cavity of the abscess. The patient fully recovered postoperatively. In the diagnosis of interhemispheric subdural abscess, it is said that conventional X-ray CT sufficiently reveals the quality of the lesion, the precise site, and the anatomical relation to the surrounding edema. In our case, MRI was able to confirm the diagnosis made by the X-ray CT. Furthermore, MRI was thought to be superior to the X-ray CT in the evaluation of the extension of the abscess and in the delineation of the surrounding edema. Combined use of X-ray CT and MRI in cases of interhemispheric abscess was considered to make the diagnosis more precise in both qualitative and quantitative aspects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diabetes mellitus as a risk factor in major hepatic resection and its strategy by intraportal insulin administration].

Diabetes mellitus, or insulinopenia, is a possible risk factor in major hepatic resection, because insulin is a typical hepatotrophic factor governing hepatic mitochondrial function. By analyzing 91 hepatic resections for hepatocellular carcinoma, we made a multiple regression equation for prediction of postoperative mortality using insulinogenic index (II) and redox tolerance index (RTI) which were both calculated by measuring insulin level and arterial ketone body ratio during oral glucose tolerance test (z = 3.11 x II + 1.43 x RTI - 2.27). When z was negative, the mortality rate was 33.3% in major hepatic resection cases. Since 1990, we have prospectively applied intraportal insulin administration (IIA) therapy as postoperative management to patients with negative z score. In the total 19 patients the postoperative mortality was significantly reduced by the introduction of IIA therapy. Hence, the IIA therapy can be a strategy against diabetes mellitus as a risk factor in major hepatic resection.

Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic features.

BACKGROUND AND PURPOSE: Determining factors for performing carotid endarterectomy (CEA) are the severity of carotid stenosis and the presence of plaque ulcerations. Precise detection of these factors is important. The aim of this study was to assess the applicability of using B-mode ultrasonography for diagnosing carotid lesions in patients undergoing CEA. METHODS: B-mode examinations were performed on 64 Japanese patients (68 arteries) who subsequently underwent CEA. In each case, the appearance of plaque on B-mode was classified into one of two types: heterogeneous or homogeneous; plaque echogenicity was expressed as hypoechoic, isoechoic, or hyperechoic. Surface characteristics such as ulceration also were examined, and the degree of carotid artery stenosis was calculated. The B-mode findings were compared with angiographic and pathological features. RESULTS: B-mode accurately visualized macroscopic ulceration and surface irregularity in 93.8% of the lesions examined, which was superior to angiography. Fifty-four lesions (79.4%) were of the heterogeneous type and 14 lesions (20.6%) were of the homogeneous type on B-mode. Microscopically, 57.4% of the heterogeneous-type lesions demonstrated fibrous change. The frequency of calcification was higher in the heterogeneous lesions than in the homogeneous lesions. CONCLUSION: B-mode ultrasonography findings can provide information about macroscopic and microscopic characteristics of carotid lesions.

Clinical evaluation of a newly developed enteric nutrient given to the neurosurgical patients with disturbances of consciousness.

An enteric nutrient 'SAN-ET-A', rich in protein and electrolytes, was given to 8 patients with disturbances of consciousness. Although the adminstered dosage had a calorie content so low that basal metabolism was barely maintained, the level of serous proteins increased following administration. Electrolyte imbalance was not found, and the patients did not suffer from severe renal or liver dysfunctions. No notable gastrointestinal troubles occurred except in one case. It is concluded that a low dosage of SAN-ET-A was sufficient to maintain the patients in good nutritional condition. Furthermore, it is suggested that this nutrient can be safely given for a long period.