[Emergent Off-pump Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Report of a Case].

Dextrocardia associated with situs inversus totalis is a rare congenital anomaly. We herein report a patient with this condition and ischemic coronay artery disease who underwent emergency surgical myocardial revascularization. A 76-year-old man was admitted to our hospital with a diagnosis of unstable angina pectoris. He had incessant ventricular fibrillation attack on the second day of hospitalization. Emergent coronary angiography revealed total obstruction of the anatomically left anterior descending and right coronary arteries, and severe stenosis in the anatomically left circumflex artery. Emergent off-pump coronary artery bypass using saphenous vein grafts was successfully performed. Intraoperatively, the main surgeon continuouly stood on the patient's right side except during anastosiso of a vein graft to the left circumflex artery. Postoperative course was almost uneventful aside from transient renal replacement and prolonged ventilation.

[Spontaneous Renal Rupture of Acquired Cystic Kidney Disease after Coronary Artery Bypass Grafting:Report of a Case].

We described a hemodialysis patient with spontaneous renal rupture of acquired cystic kidney disease (ACKD) after off-pump coronary artery bypass grafting(OPCAB). A 53-year-old man was transfer to our hospital with a diagnosis of unstable angina pectoris. He became ventilated due to congestive heart failure 3 days and underwent OPCAB on schedule 6 days after hospitalization. He suddenly complainted of colicky frank pain 31 days after surgery. Computed tomography (CT) demonstrated bulky hematoma with swollen kidney. Treatment included blood transfusions, withdrawal of anticoagulation, administration of vitamin K, and bed rest. The patient's symptom disappeared. A month later CT showed that the hematoma had been absorbed.

[Coronary Artery Bypass Grafting to the Left Anterior Descending Artery via Anterior Minithoracotomy after Surgery for Acute Papillary Muscle Rupture;Report of a Case].

We presented a case with chronic occlusion of the left anterior descending artery(LAD) after mitral valve replacement (MVR). An 80-year-old man was transferred to our hospital with a diagnosis of acute myocardial infarction. Before coronary angiography, the patient suddenly fell in a state of cardiogenic shock. Echocardiography revealed acute mitral regurgitation due to anterior papillary muscle rupture. Although emergency MVR was performed, introduction of percutaneous cardiopulmonary support (PCPS) and intraaortic balloon pumping ( IABP) was needed to come off cardiopulmonary bypass. Postoperative coronary angiography revealed chronic occlusion of LAD. The left internal thoracic artery was anastomosed to LAD via anterior minithracotomy to avoid median re-sternotomy. The postoperative course was uneventful and the cardiac function improved.

Diagnostic value of ¹8F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma.

PURPOSE: This study investigated the diagnostic accuracy of hybrid positron-emission tomography/computed tomography (PET/CT) for lymph node (LN) metastasis of esophageal cancer. We also investigated the correlation between the size of metastatic nests and the detection by PET/CT. METHODS: Two hundred and fifty-eight patients with esophageal squamous cell carcinoma who underwent esophagectomy with two- or three-field radical lymphadenectomy were analyzed retrospectively. We compared the diagnosis of preoperative PET/CT to the postoperative histopathological examination by each anatomical field (n = 1,231) in all 258 patients. The metastatic LNs resected from PET/CT positive fields were classified as belonging to the PET/CT-N-positive group (n = 229) and those from negative fields as belonging to the PET/CT-N-negative group (n = 352). The cross-sectional areas of metastatic nests were measured in each metastatic LN. RESULTS: Of the 1,231 fields, 275 (22 %) were positive for metastasis, including 581 LNs from 408 regional LN stations. The sensitivity and specificity of PET/CT examined by each anatomical field were 25.8 and 97.8 %, respectively. The median area of metastatic nests was 17.7 mm2 in the PET/CT-N-positive group, and 7.7 mm2 in the PET/CT-N-negative group (p < 0.001). CONCLUSIONS: A significant correlation was suggested between the nest size and detection by PET/CT. Because of its low sensitivity, PET/CT alone is insufficient to determine the surgical procedures, especially when considering reduction surgery.

Production of polyselenodipenicillamines, unique selenium compounds.

Selenite (H(2)SeO(3)) reacts with thiol compounds (RSH) under acidic conditions to form selenotrisulfides (RSSeSR, i.e. monoselenodithiols). The stoichiometry of the reaction is proposed as 4RSH+H(2)SeO(3)-->RSSeSR+RSSR+3H(2)O. Surprisingly, we found novel polynuclear selenium-containing compounds, i.e. polyselenodipenicillamines (PenSSe(2-4)SPen), in the reaction of D-penicillamine (PenSH) with H(2)SeO(3). The selenium-centered features of PenSSe(2-4)SPen were determined by (1)H-NMR and LC-MS/MS analyses, showing that the selenium isotope abundance patterns of the compounds were in good agreement with the theoretically-calculated ones. In order to better understand the mechanisms for PenSSe(2-4)SPen production, various molar ratio of H(2)SeO(3) (1/8 to 4 times of PenSH) was reacted with PenSH, and the concentration of the products was calculated from integral values of dimethyl proton signals for PenSSe(1-2)SPen as compared with methyl proton signals for acetic acid (an internal standard). Total PenSSe(1-2)SPen concentration was increased with increasing of H(2)SeO(3), in which concomitant decrease of PenSSPen (disulfide form of PenSH) was observed. Based on these results, we proposed the PenSSe(2-4)SPen production mechanisms being involved in penicillamine selenopersulfides (PenSSe(1-2)H).

Measurement of shear bond strength to intact dentin.

Previously, we reported that the integrity of a resin composite restoration deteriorated when the dentin cavity wall was decalcified by conditioning. In this study, to evaluate the bonding between dentin adhesive and non-decalcified dentin surface, we experimented with a novel method of using a high-pressure water spray device to prepare smear layer-free dentin surfaces. When the smear layer was removed, shear bond strength significantly increased regardless of the removal method employed. Further, with glyceryl monomethacrylate (GM) priming, no significant differences in bond strength were observed among these smear layer removal methods: ethylenediamine tetraacetic acid (EDTA) conditioning, phosphoric acid conditioning, and removal by water spray. It was also found that GM priming was key to achieving marginal integrity, whereas contraction gap width increased with phosphoric acid conditioning. It was thus concluded that the efficacy of a dentin adhesive should be evaluated by consistently observing the contraction gap in three-dimensional cavities rather than by mere measurement of bond strength to a flat dentin surface.

High metabolic heterogeneity on baseline 18FDG-PET/CT scan as a poor prognostic factor for newly diagnosed diffuse large B-cell lymphoma.

Metabolic heterogeneity (MH) can be measured using 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT), and it indicates an inhomogeneous tumor microenvironment. High MH has been shown to predict a worse prognosis for primary mediastinal B-cell lymphoma, whereas its prognostic value in diffuse large B-cell lymphoma (DLBCL) remains to be determined. In the current study, we investigated the prognostic values of MH evaluated in newly diagnosed DLBCL. In the training cohort, 86 patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapies were divided into low-MH and high-MH groups using receiver operating characteristic analysis. MH was not correlated with metabolic tumor volume of the corresponding lesion, indicating that MH was independent of tumor burden. At 5 years, overall survivals were 89.5% vs 61.2% (P = .0122) and event-free survivals were 73.1% vs 51.1% (P = .0327) in the low- and high-MH groups, respectively. A multivariate Cox-regression analysis showed that MH was an independent predictive factor for overall survival. The adverse prognostic impacts of high MH were confirmed in an independent validation cohort with 64 patients. In conclusion, MH on baseline 18FDG-PET/CT scan predicts treatment outcomes for patients with newly diagnosed DLBCL.

Can hybrid FDG-PET/CT detect subclinical lymph node metastasis of esophageal cancer appropriately and contribute to radiation treatment planning? A comparison of image-based and pathological findings.

BACKGROUND: We aimed to determine the appropriateness of adding 18F-fluorodeoxyglucose (FDG)-positronemission tomography (PET) to computed tomography (CT) and other pre-existing diagnostic imaging modalities for detecting subclinical lymph node metastasis of esophageal cancer, by comparing images from these modalities with the results of histopathological analysis. METHODS: Twenty patients who received radical surgery for squamous cell carcinoma of the esophagus were examined by PET-CT, and endoscopic ultrasound (EUS) examination before surgery. Based on these diagnostic modalities, the clinical target volume (CTV) was set as the gross tumor volume (GTV) plus a 1-cm margin. Histopathological diagnosis was performed in all patients immediately after resection. RESULTS: Fifty-three (3.0%) of 1764 nodes in the 20 patients were histopathologically positive for cancer cells. The CTV was not adequate to cover these histopathologically detected positive lymph nodes in 8 of 20 patients on CT, 5 of 20 on CT+EUS, 7 of 20 on PET-CT, and 5 of 20 on PET-CT+EUS. CONCLUSION: The detection rate of subclinical lymph node metastasis did not improve with the use of PET-CT, for either the cervical and supraclavicular, mediastinal, or abdominal regions. It is not recommended to use FDG-PET or PET-CT alone as a diagnostic tool to determine CTV if pathologically involved lymphatic regions are to be included in the CTV in the treatment protocol. The accuracy of PET-CT must be further improved in order to better detect positive nodes and improve the definition of the CTV.

In vitro comparison of three caries dyes.

PURPOSE: To evaluate the efficacy of a conventional and newly-developed caries detector (Caries Check) by measuring the Vickers microhardness (VMH) and DIAGNOdent value of the dentin cavity wall of extracted human teeth after removing carious dentin that was stained by the caries detector. METHODS: 30 human teeth with coronal dentin caries extending halfway through the dentin were sectioned and extracted for use in this study. As a control, the longitudinal section of a caries-free extracted human tooth was prepared. The VMH and DIAGNOdent values were measured and the microstructure of the dentin cavity wall was examined using a scanning electron microscope (SEM). RESULTS: When Caries Check was employed as a guide for carious dentin removal, the microhardness of the cavity wall was significantly lower than the normal dentin and the DIAGNOdent value indicated that the dentin may have recalcified. SEM observations of the stained regions revealed that Caries Check did not stain the sclerotic dentin. Based on these findings, Caries Check may be a useful modality because the excavation of the dentin structure was shallower and the sclerotic dentin was preserved.

Serum level of soluble interleukin-2 receptor is positively correlated with metabolic tumor volume on 18 F-FDG PET/CT in newly diagnosed patients with diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin lymphoma. High total metabolic tumor volume (TMTV) calculated using 18 F-FDG PET/CT images at diagnosis predicts poor prognosis of patients with DLBCL. However, high cost and poor access to the imaging facilities hamper wider use of 18 F-FDG PET/CT. In order to explore a surrogate marker for TMTV, we evaluated the correlation between the serum levels of soluble interleukin-2 receptor (sIL-2R) and TMTV in 64 patients with DLBCL, and the results were verified in an independent validation cohort of 86 patients. Serum levels of sIL-2R were significantly correlated with TMTV. ROC analysis revealed that the cutoff value of TMTV ≥150 cm3 or sIL-2R ≥ 1300 U/mL could predict failure to achieve EFS24 with areas under the curve (AUC) 0.706 and 0.758, respectively. Each of TMTV ≥150 cm3 and sIL-2R ≥1300 U/mL was significantly associated with worse 5-year overall survival and event-free survival. Importantly, each of sIL-2R <1300 U/mL or TMTV <150 cm3 identified patients with favorable prognosis among NCCN-IPI high-intermediate and high-risk group. Serum level of sIL-2R represents a convenient surrogate marker to estimate metabolic tumor burden measured by 18 F-FDG PET/CT that can predict treatment outcomes of patients with DLBCL.

Brain-derived neurotrophic factor participates in determination of neuronal laminar fate in the developing mouse cerebral cortex.

Lamina formation in the developing cerebral cortex requires precisely regulated generation and migration of the cortical progenitor cells. To test the possible involvement of brain-derived neurotrophic factor (BDNF) in the formation of the cortical lamina, we investigated the effects of BDNF protein and anti-BDNF antibody separately administered into the telencephalic ventricular space of 13.5-d-old mouse embryos. BDNF altered the position, gene-expression properties, and projections of neurons otherwise destined for layer IV to those of neurons for the deeper layers, V and VI, of the cerebral cortex, whereas anti-BDNF antibody changed some of those of neurons of upper layers II/III. Additional analysis revealed that BDNF altered the laminar fate of neurons only if their parent progenitor cells were exposed to it at approximately S-phase and that it hastened the timing of the withdrawal of their daughter neurons from the ventricular proliferating pool by accelerating the completion of S-phase, downregulation of the Pax6 (paired box gene 6) expression, an essential transcription factor for generation of the upper layer neurons, and interkinetic nuclear migration of cortical progenitors in the ventricular zone. These observations suggest that BDNF participates in the processes forming the neuronal laminas in the developing cerebral cortex. BDNF can therefore be counted as one of the key extrinsic factors that regulate the laminar fate of cortical neurons.

Light intensity evaluation of laser-induced fluorescence after caries removal using an experimental caries staining agent.

OBJECTIVE: The purpose of this study was to evaluate the intensity of fluorescent light reflected from cavity wall dentin, after dentin stained by an experimental caries detecting liquid was removed. BACKGROUND DATA: The conventional caries detecting liquid tends to penetrate dentin too deeply. On the other hand, DIAGNOdent has gradually gained recognition and established itself as a caries detection device using a laser beam. METHOD: An experimental caries staining liquid or the conventional caries staining liquid was applied in the same cavity to observe for differences in dye penetration. Intensity of fluorescence reflected from treated dentin was measured by DIAGNOdent. RESULTS: The mean DIAGNOdent value after removing the tooth substance stained by the experimental liquid was 17.9+/-4.1, compared with 7.7+/-2.7 by conventional one. CONCLUSION: Light intensity evaluation of laser-induced fluorescence suggested that the experimental caries detecting liquid did not penetrate the dentin which should be preserved, hence avoiding overtreatment.

Priming effects of triethylene glycol and triethylene glycol monomethacrylate on dentin bonding.

The objective of this study was to evaluate the effects of triethylene glycol (TEG) and triethylene glycol monomethacrylate (TEGMA) solutions as dentin primers on dentin bonding. To this end, wall-to-wall polymerization contraction gap width of a resin composite in a cylindrical dentin cavity and shear bond strength to a flat dentin surface were measured. Dentin was pretreated with an experimental dentin bonding system - consisting of 0.5 M ethylenediaminetetraacetic acid conditioner, TEG or TEGMA primer, and Clearfil Photo Bond bonding agent - prior to resin composite filling. When the cavity was primed with an aqueous solution of 35 vol% TEG, 35 or 45 vol% TEGMA for a few seconds, contraction gap formation was prevented completely. Then, among these three gap-free groups, there were no significant differences in shear bond strength. It was thus shown that both TEG and TEGMA were highly effective dentin primers, completely preventing contraction gap formation even when they were applied for only a few seconds.

Guinea Pig Maximization Test of tri-ethylene glycol mono-methacrylate.

The aim of this study was to evaluate tri-ethylene glycol mono-methacrylate (TEGMA) in terms of dermatological allergic reaction using a Guinea Pig Maximization Test. Skin reaction was evaluated according to the criteria of International Contact Dermatitis Research Group. TEGMA, as a constituent in new primers, has been reported to contribute to a priming ability similar to that of highly purified glyceryl mono-methacrylate (GM). In this study, it was found that its adverse effect was less than that of 2-hydroxy ethyl methacrylate (2-HEMA), but similar to that of highly purified GM. In conclusion, it was anticipated that TEGMA would hereafter replace 2-HEMA as a primer, as it posed a lower risk of triggering dermatological allergic reaction.

Projections of glutamate decarboxylase positive and negative cerebellar neurons to the pretectum in the cat.

The pretectum is one of the primary visual centers, and plays an important role in the visuomotor reflexes. It also receives projections from the cerebellar nuclei that are considered to regulate these reflexes. Gamma aminobutylic acid (GABA) and glutamate are supposed to be two major neurotransmitters of the projection neurons of the cerebellar nuclei. We double labeled the projecting neurons with a tracer, biotinylated dextran amine (BDA), and with an antiserum to glutamate decarboxylase (GAD), the enzyme that synthesizes GABA. The results indicated that about 40% of the pretectal-projecting neurons of the cerebellar nuclei were GAD immunoreactive. The GAD positive pretectal-projecting neurons were significantly smaller than the GAD negative projecting neurons. Our findings thus suggest the existence of two distinct cerebello-pretectal projection systems: one is mediated by GABAergic inhibitory projections, while the other is mediated by non-GABAergic, probably glutamatergic excitatory ones.

Formation of estrogenic products from environmental phthalate esters under light exposure.

Phthalate esters (PEs) have been suspected to be environmental endocrine disruptors and the detailed mechanism remains unclear. The activities of these chemicals can be enhanced through chemical modification under the environmental conditions. We demonstrate that PEs acquire unequivocal estrogenic activity by light exposure. Through UV exposure of an aqueous PE solution, one active photoproduct, identified as 4-hydroxyPE (PE-4OH) based on its characteristic UV and mass spectra, was detected in an estrogen receptor alpha-dependent transactivation assay. PE-4OH was effectively generated by UV 290 nm. The PE-4OH production accompanied H2O2 generation in a UV dose-dependent manner. Both PE and UV irradiation were indispensable in the generation of H2O2. Addition of H2O2 to the PE solution increased PE-4OH production under UV irradiation. The PE-4OH production was also observed in the PE reaction with the Fenton reagent generating hydroxyl radical without UV irradiation. The proposed mechanism for PE-4OH production based on these results is such that by PE-mediated photosensitization H2O2 is generated from O2 and H+ and decomposed to hydroxyl radical, thus oxidizing the PE benzene ring. The PEs-4OH are remarkably active estrogenic products of PEs and would be involved in ER-mediated endocrine disruption.

Contraction gap versus shear bond strength of dentin adhesive in sound and sclerotic dentins.

To evaluate the effect of a dentin adhesive on sclerotic dentin, contraction gap width and shear bond strength were measured. Dentin cavity wall was pretreated with an experimental dentin bonding system with and without a dentin primer, or with a commercial dentin bonding system. In the experimental dentin bonding groups, contraction gap width of sclerotic dentin was significantly smaller than that of sound dentin when the cavity was not primed with glyceryl monomethacrylate. For each individual tooth, the correlation between contraction gap width and shear bond strength was insignificant. In conclusion, the bonding efficacy of dentin bonding systems to sclerotic dentin was superior to that of sound dentin. Further, it was determined that it was impossible to detect the interaction between the polymerization contraction stress of resin composites and the efficacy of dentin adhesives by measuring bond strength.

[Case in which landiolol hydrochloride improved left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve following mitral valve plasty].

We report a case of left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion of the mitral valve (SAM) following mitral valve plasity (MVP). A 65-year-old man underwent mitral valve plasty for grade III mitral valve regurgitation. The plasty was done smoothly and the patient was weaned from cardiopulmonary bypass successfully with continuous dobutamine infusion. However, about 30 minutes after the weaning, severe cardiovascular collapse developed. Inotropic agent, such as dobutamine, ephedrine, or calcium hydrochloride was not effective. Trans-esophageal echocardiography (TEE) showed severe mitral valve regurgitation with LVOT obstruction due to SAM. The collapse was successfully treated with volume loading and a small amount of a beta1-adrenergic antagonist, landiolol hydrochloride. We conclude that acute LVOT obstruction with SAM could develop following MVP. TEE was a much useful tool for early diagnosis and landiolol hydrochloride would be a notable agent for nonsurgical treatment of LVOT obstruction with SAM.

Ventral lateral geniculate nucleus projects to the dorsal lateral geniculate nucleus in the cat.

The lamina C3 of the dorsal lateral geniculate nucleus of the cat does not receive retinal projections but instead receives visual information from the small subpopulation of W-type ganglion cells via the upper substratum of the stratum griseum superficiale of the superior colliculus. We herein report a projection from the lateral division of the ventral lateral geniculate nucleus into the lamina C3 of the dorsal lateral geniculate nucleus. As the lateral division receives projections from the contralateral retina and the ipsilateral upper stratum griseum superficiale of the superior colliculus, we suggest that these regions make up a small cell type W-cell neuronal network that provides visual information to layer I of the striate cortex via the lamina C3.

Cytoarchitectonic and connectional organization of the ventral lateral geniculate nucleus in the cat.

The ventral lateral geniculate nucleus is a small extrageniculate visual structure that has a complex cytoarchitecture and diverse connections. In addition to small-celled medial and lateral divisions, we cytoarchitectonically defined a small-celled dorsal division. A large-celled intermediate division intercalated between the three small-celled divisions, which we divided into medial and lateral intermediate subdivisions. In WGA-HRP injection experiments, the different cytoarchitectonic divisions were shown to have connections with different nuclei. The medial division was reciprocally connected to the pretectum and projected to the superficial layers of the superior colliculus and the intralaminar nuclei. The medial intermediate division received projections from the intermediate layer of the superior colliculus and the lateral and interpositus posterior cerebellar nuclei, and projected to the intermediate layer of the superior colliculus, the periaqueductal gray of midbrain, and the intralaminar nuclei. The lateral intermediate divisions received projections from the pretectum, the intermediate layer of the superior colliculus, and the lateral and interpositus posterior cerebellar nuclei, and projected to the pretectum, superficial layers of the superior colliculus, and the pulvinar. The lateral division received projections from superficial layers of the superior colliculus and had reciprocal connections with the pretectum. The dorsal division received projections from the pretectum and had reciprocal connections with the periaqueductal gray of midbrain. The different cytoarchitectonic divisions of the ventral lateral geniculate nucleus are thus suggested to play different functional roles related to vision, eye and head movements, attention, and defensive reactions.