Postoperative anemia following posterior decompression surgery for lumbar spinal canal stenosis.

The incidence of lumbar spinal canal stenosis (LSCS) is increasing in Japan. Posterior lumbar decompression surgery, wide fenestration and laminectomy, for LSCS is a common treatment modality. Compared with posterior fusion surgery, posterior decompression surgery has been considered as less invasive. However, no reports regarding postoperative anemia following posterior decompression surgery have been published. In this retrospective study, we evaluated changes in hemoglobin values following wide fenestration in 80 patients with LSCS based on the number of operated levels, and also analyzed the differences between intraoperative and postoperative bleeding volume. Two patients required allogenic transfusion. The mean preoperative hemoglobin values were 13.6 g/dL and the mean postoperative minimum hemoglobin values were 11.2 g/dL. The mean hemoglobin values decreased by 1.8 g/dL in patients with one operated level (n = 15); 2.2 g/dL in those with two operated levels (n = 31); 2.6 g/dL in those with three operated levels (n = 23); and 3 g/dL in those with four operated levels (n = 11). The mean decrease in hemoglobin values was calculated as follows: 1.8 + 0.4 × (X - 1), where X was the number of operated levels. The mean intraoperative bleeding volume was 94 ml and the mean postoperative bleeding volume was 418 ml. Postoperative bleeding volume was significantly larger than intraoperative bleeding volume. Accordingly, postoperative hemoglobin values can be predicted in patients undergoing wide fenestration. Effective management of postoperative bleeding is necessary to prevent postoperative anemia.

Sarcoidosis in the aged: review and management.

PURPOSE OF REVIEW: We intend to update the data of various clinical features and management of sarcoidosis in the aged. RECENT FINDINGS: Subclinical or inapparent systemic involvement of sarcoidosis was found at autopsy in elderly patients who died from sarcoidosis, complication of malignancy, or cerebrovascular accidents. Sarcoidosis in the aged presents with unusual intrathoracic and extrapulmonary clinical features. Occasionally, these features may masquerade as malignancy. Sarcoidosis may appear or reactivate in patients receiving treatment with tumor necrosis factor antagonists or antiviral treatment. In elderly patients, antitumour necrosis factor treatment is effective for refractory sarcoidosis, methylphenidate hydrochloride for fatigue, and bosentan for sarcoidosis-associated pulmonary hypertension. Inhaled prostacyclin has been found to be effective in some patients with pulmonary hypertension. Sarcoidosis and malignancy can coexist. SUMMARY: Autopsy studies revealed that both apparent and subclinical or inapparent systemic involvement of sarcoidosis might exist in aged patients with sarcoidosis. Aged sarcoidosis patients often present with unusual clinical features of sarcoidosis. Occasionally, these features resemble malignancy. New treatment with tumor necrosis factor antagonists for intractable sarcoidosis, methylphenidate hydrochloride for fatigue, and bosentan for sarcoidosis-associated pulmonary hypertension may be effective in sarcoidosis in the aged. Sarcoidosis and malignancy may coexist.

Oleuropein, a phenolic compound in extra virgin olive oil, increases uncoupling protein 1 content in brown adipose tissue and enhances noradrenaline and adrenaline secretions in rats.

The effects of oleuropein, a phenolic compound in extra virgin olive oil (EV-olive oil), on triglyceride metabolism were investigated by measuring the degree of thermogenesis in interscapular brown adipose tissue (IBAT), and noradrenaline and adrenaline secretions in rats. In Experiment 1, rats were given a high-fat diet (control diet) with the oleuropein supplementation of 1, 2 or 4 mg/kg of diet (0.1, 0.2 or 0.4% oleuropein diet, respectively). After 28 d of feeding, body weight, perirenal adipose tissue, epididymal fat pad, and plasma triglyceride, free fatty acid and total cholesterol concentrations were reduced by the 0.1, 0.2 or 0.4% oleuropein diet and were significantly lowest in rats fed the 0.4% oleuropein diet, as compared with those of rats fed with the control diet. The content of uncoupling protein 1 (UCP1) in IBAT and urinary noradrenaline and adrenaline excretions were significantly higher in rats fed the 0.1 or 0.2% oleuropein diet, as compared with those of rats fed with the control diet, although there were no significant differences in rats fed the 0.4% oleuropein diet. In Experiment 2, the effects of oleuropein on noradrenaline and adrenaline secretion were evaluated. The intravenous administration of oleuropein and oleuropein aglycone significantly increased plasma noradrenaline and adrenaline concentrations. Furthermore, oleuropein aglycone induced the secretions of noradrenaline and adrenaline about ten fold more potently than oleuropein. These results suggest that the phenolic compound oleuropein in EV-olive oil enhances thermogenesis by increasing the UCP1 content in IBAT and noradrenaline and adrenaline secretions in rats.

Patient dose estimation for multi-detector-row CT examinations.

The spread of Multi-detector-row computed tomography (MDCT) has been remarkable. Here, various organ and tissue doses were evaluated with six types of MDCT scanners in common use in Japan; using thermoluminescence dosimeters and anthropomorphic phantoms under condition of routine clinical examinations of the chest in adult and child, of the head in child and of the abdomen-pelvis in adult. Estimated lung doses and averaged effective dose in chest examinations were 19.2 +/- 2.03 mGy and 9.54 +/- 0.90 mSv for the adult and 15.7 +/- 1.88 mGy and 7.42 +/- 0.82 mSv for the child phantom, respectively. The numerical difference between effective dose and organ or tissue doses was about 2-2.5 times. For the adult abdomen-pelvis examinations, averaged effective dose was 13.0 +/- 3.72 mSv. Averaged effective dose for the child head examinations was 2.6 +/- 1.32 mSv. In one case, the dose approached 80 mGy for the brain in the head examination, giving a difference from the effective dose of 10 times or more.

Extra virgin olive oil increases uncoupling protein 1 content in brown adipose tissue and enhances noradrenaline and adrenaline secretions in rats.

The effects of extra virgin olive oil (EV-olive oil) on triglyceride metabolism were investigated by measuring the degree of thermogenesis in interscapular brown adipose tissue (IBAT) and the rates of noradrenaline and adrenaline secretions in rats, both in vivo and in situ. In Experiment 1 (in vivo), rats were given an isoenergetic high-fat diet (30% fat diet) containing corn oil, refined olive oil, or EV-olive oil. After 28 days of feeding, the final body weight, weight gain, energy efficiency, perirenal adipose tissue and epididymal fat pad and plasma triglyceride concentrations were the lowest in the rats fed the EV-olive oil diet. The content of uncoupling protein 1 (UCP1) in IBAT and the rates of urinary noradrenaline and adrenaline excretions were the highest in the rats fed the EV-olive oil diet. In Experiment 2 (in situ), the effects of the extract of the phenolic fraction from EV-olive oil and a compound having excellent characteristics as components of EV-olive oil, hydroxytyrosol, on noradrenaline and adrenaline secretions were evaluated. The intravenous administration of the extract of the phenolic fraction from EV-olive oil significantly increased plasma noradrenaline and adrenaline concentrations, whereas that of hydroxytyrosol had no effect. These results suggest that phenols except hydroxytyrosol in EV-olive oil enhance thermogenesis by increasing the UCP1 content in IBAT and enhancing noradrenaline and adrenaline secretions in rats.

Estimation of uncertainties on dose calculations of the 99mTc-MDP-injected patients in nuclear medicine.

The internal exposures of the patients in nuclear medicine can be calculated based on the equations and data in ICRP Publications 53 and 80. Physical and biological parameters are used for the calculation, and both include uncertainties. Physical parameters can be considered as more precise than biological parameters, so that uncertainties originated from biological parameters are more important. Absorbed fractions (AFs) have been calculated by Monte-Carlo method using medical internal radiation dose (MIRD)-type mathematical phantoms. They depend on the shapes and sizes of the phantoms used in simulations. For estimating shape- and size-related uncertainties, AFs of pairs of source regions and target tissues of the patient-injected 99mTc-MDP were calculated by using EGS4 codes and a voxel phantom of Japanese male. By simply resizing the voxels of the phantom, the dependencies of size for AFs were calculated, and the uncertainties caused by the cumulated activities in source regions were also estimated by assuming these parameters distributions as Gaussian.

Oleuropein aglycone enhances UCP1 expression in brown adipose tissue in high-fat-diet-induced obese rats by activating ß-adrenergic signaling.

Oleuropein is the pungent principle of raw olives. Oleuropein aglycone (OA) is a major phenolic compound in extra virgin olive oil and the absorbed form of oleuropein. We aimed to determine the mechanism underlying the nutritional effects of oleuropein and OA on interscapular brown adipose tissue (IBAT) in rats with high-fat (HF) diet-induced obesity by examining the agonistic activity of oleuropein and OA toward the transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1). Four-week-old male Sprague-Dawley rats were fed an HF (palm oil 30% wt:wt) diet alone or with oleuropein (HF-O, 1 g/kg diet) for 28 days. In rats fed HF-O compared to HF, urinary noradrenaline, adrenaline and UCP1 levels in IBAT were significantly higher, whereas plasma leptin levels and the total weight of the abdominal cavity adipose tissue were significantly lower. In anaesthetized 7-week-old male Sprague-Dawley rats, the OA (3.8 mg of intravenous injection)-induced increase in plasma noradrenaline secretion was suppressed by TRPA1 or TRPV1 antagonist and by a ß2- or ß3-adrenoceptor antagonist. Furthermore, OA-activated rat and human TRPV1s expressed on HEK293 cells at the same level as zingerone (pungent component in ginger). OA also activated humanTRPA1, and its potency was approximately 10-fold stronger than that for TRPV1. These findings suggest that OA is the agonist of both TRPA1 and TRPV1 and that OA enhances UCP1 expression in IBAT with a concomitant decrease in the visceral fat mass of HF-diet-induced obese rats through enhanced noradrenaline secretion via ß-adrenergic action following TRPA1 and TRPV1 activation.

Comparison of image performance between cone-beam computed tomography for dental use and four-row multidetector helical CT.

The authors evaluated the imaging performance of cone-beam computed tomography (CBCT) for dental use using 3DX multi-image micro-CT (Morita Co., Kyoto, Japan) and four-row multi-detector helical computed tomography (MDCT) using an Asteion (Toshiba, Tokyo, Japan). A dried right maxillary bone was cut into eight slices 2 mm thick toward the zygomatico-palate and used as a phantom. Images of the phantom were then taken using 3DX and MDCT. The images of two bone slices were evaluated by five dentists for image quality and reproducibility of cancellous bone, as well as enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and the overall image. Using the MDCT images as the standard, the 3DX images were evaluated with a subjective 5-level scale: 3 for an image equal to the MDCT image, 4 or greater for better, and 2 or lower for worse. The scores for all parameters exceeded 4 points. Maximum mean score was 4.8 for the lamina dura. Statistically significant differences were found for all items (P < 0.01). Our subjective evaluation of imaging performance clarified that 3DX was superior to MDCT. The results of this study suggest that 3DX is useful for imaging in the dental field.

A comparison of a new limited cone beam computed tomography machine for dental use with a multidetector row helical CT machine.

OBJECTIVE: We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses. STUDY DESIGN: Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared. RESULTS: The image quality of the 3DX was better than the multidetector CT for all items (P < .01). Moreover, the mean skin doses with the multidetector CT were 458 mSv per examination, whereas the doses with the 3DX were 1.19 mSv per examination. CONCLUSIONS: These results clearly indicate the superiority of the 3DX in the display of hard tissues in the dental area while substantially decreasing the dose to the patient.

Oleuropein supplementation increases urinary noradrenaline and testicular testosterone levels and decreases plasma corticosterone level in rats fed high-protein diet.

The effects of oleuropein, a phenolic compound in extra virgin olive oil, on protein metabolism were investigated by measuring testicular testosterone and plasma corticosterone levels in rats fed diets with different protein levels. In Experiment 1, rats were fed experimental diets with different protein levels (40, 25 and 10 g/100 g casein) with or without 0.1 g/100 g oleuropein. After 28 days of feeding, the testosterone level in the testis was significantly higher and the plasma corticosterone level was significantly lower in rats fed the 40% casein diet with oleuropein than in those fed the same diet without oleuropein. The urinary noradrenaline level, nitrogen balance and hepatic arginase activity were significantly higher in rats fed the 40% casein diet with oleuropein supplementation than in those fed the 40% casein diet without oleuropein supplementation. In Experiment 2, the effects of oleuropein aglycone (a major phenolic compound in extra virgin olive oil and the absorbed form of oleuropein ingested in the gastrointestinal tracts) on the secretion of luteinizing hormone (LH) from the pituitary gland, which regulates testosterone production in the testis, were investigated in anesthetized rats. Plasma LH level increased dose dependently after the administration of oleuropein aglycone (P<.001, r=0.691). These findings suggest that dietary supplementation with 0.1 g/100 g oleuropein alters the levels of hormones associated with protein anabolism by increasing urinary noradrenaline and testicular testosterone levels and decreasing plasma corticosterone level in rats fed a high-protein diet.

Discrepancy of coronal morphology between mandibular condyle and fossa is related to pathogenesis of anterior disk displacement of the temporomandibular joint.

OBJECTIVE: To evaluate whether morphological discrepancy between the mandibular condyle and fossa of the temporomandibular joint (TMJ) is related to disk displacement on magnetic resonance imaging (MRI). STUDY DESIGN: This study included 61 patients with unilateral internal derangement based on both MRI and clinical examination. Coronal morphologies of the condyle and fossa were divided into four groups based on Öberg's classification. According to the coronal morphology of the condyle and fossa, all joints were dichotomized into either harmonized group or a discrepancy group (e.g., angled condyle and concave fossa). The incidence of discrepancy and the relationship of the discrepancy to other findings on MRI were statistically evaluated. RESULTS: The discrepancy had a significantly higher incidence on the affected side. The discrepancy correlated with incidence of disk deformity on the affected side. CONCLUSION: Morphological discrepancy between the condyle and fossa is related to development of anterior disk displacement in the TMJ.

Microorganisms causing pyogenic spondylitis: comparison of community and hospital-acquired types.

Abstract Pyogenic spondylitis is a common infectious disease caused by various microorganisms. It is difficult to predict the infecting microorganism at the time of initiation of treatment. Pneumonia is generally clarified into community or hospital-acquired types based on where the infection was acquired, and the infecting microorganisms are different for each type. We retrospectively analyzed 20 cases of pyogenic spondylitis treated in our hospital and categorized the cases into community and hospital-acquired types. We also identified the infecting microorganisms and the rate of sepsis in each type. There were 12 cases of community-acquired and 8 of hospital-acquired infection. The major infecting microorganisms responsible for the community-acquired type were Gram-positive cocci, and those responsible for the hospital-acquired type were methicillin-resistant Staphylococcus aureus and Gram-negative bacilli. The rate of sepsis was significantly different for both groups: 16% for the community-acquired type and 75% for the hospital-acquired type. The classification of pyogenic spondylitis based on where the infection was acquired may be useful for predicting which microorganisms are responsible for the disease.

Sacral fracture causing neurogenic bladder: a case report.

A 76-year-old man presented with a Denis Zone III sacral fracture after a traffic accident. He also developed urinary retention and perineal numbness. The patient was diagnosed with neurogenic bladder dysfunction caused by the sacral fracture. A computed tomogram (CT) revealed that third sacral lamina was fractured and displaced into the spinal canal, but vertebral body did not displace. The fracture lines began at the center of lamina and extended bilateraly. The fracture pattern was unique. The sacrum was osteoporosis, and this fracture may be based on osteoporosis. We performed laminectomy to decompress sacral nerve roots. One month after surgery, the patient was able to urinate. Three months after surgery, his bladder function recovered normally. One year after surgery, he returned to a normal daily life and had no complaints regarding urination. One-year postoperative CT showed the decompressed third sacrum without displacement.

The specific sagittal magnetic resonance imaging of intradural extra-arachnoid lumbar disc herniation.

Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a "Y," and, thus, we called it the "Y sign." The "Y sign" may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation.

Improvement of hip abductor muscle weakness after lumbar decompressive surgery.

INTRODUCTION: Degenerative lumbar spinal disorder is common in Japan, and the L5 nerve root is commonly involved in this disorder. The symptoms of L5 radiculopathy are irradiating lateral leg pain, and numbness and weakness of tibialis anterior and the hip abductor muscle. There has been only one report on the results of surgery for hip abductor muscle weakness caused by degenerative lumbar spinal disorder. PATIENTS AND METHODS: In this study, we analyzed the strength of the hip abductor muscle before and after decompressive surgery in 26 cases and the relationship between the lumbar disc herniation (LDH) and lumbar spinal canal stenosis (LSCS) groups. RESULTS: Of the total 26 cases, muscle strength improved in 23 cases (88%), with complete recovery in 17 cases (65%). In the LDH group, the improvement rate was 92%. In the LSCS group, the improvement rate was 68%. Although the improvement rate for the LDH group was higher than that for the LSCS group, the difference was not significant (P = 0.054). DISCUSSION: Decompressive surgery may be an effective method to improve hip abductor muscle weakness in degenerative lumbar spinal disorder.

Long-chain N-vanillyl-acylamides from Capsicum oleoresin.

N-Vanillyl-acylamides (NVAs) naturally occur as capsaicinoids in Capsicum plants. NVAs with a longer chain acyl moiety (LCNVAs) have been developed as attractive tools for medicinal usage because of their capsaicin-like bioactive and physiological properties, without harmful irritancy. In this study, we isolated four LCNVAs from Capsicum oleoresin. Their structures were determined to be N-vanillyl-hexadecanamide (palvanil, 2), N-vanillyl-octadecanamide (stevanil, 3), N-vanillyl-9E-octadecenamide (olvanil, 4), and N-vanillyl-9E,12E-octadecadienamide (livanil, 5) by spectroscopic analysis and gas chromatography-mass spectrometry analysis of their methanolysis products. Furthermore, the existence of two LCNVAs in oleoresin, N-vanillyl-tetradecanamide (myrvanil, 1) and N-vanillyl-9E,12E,15E-octadecatrienamide (linvanil, 6), was suggested. The contents of these LCNVAs and the major capsaicinoids-capsaicin and dihydrocapsaicin-in three Capsicum oleoresins and the fresh fruits of two hot peppers were measured by a liquid chromatography-tandem mass spectrometry system. The content ratios of the total LCNVAs, except for myrvanil, versus the capsaicin in the oleoresins (0.1-41%) was significantly larger than that in fresh fruits (<0.01%). The composition of these LCNVAs in each oleoresin was similar to that of fatty acids in the oil fraction of each oleoresin. We observed no relationship between the composition of these LCNVAs in the fresh fruits.

Characterization of Propionibacterium acnes isolates from sarcoid and non-sarcoid tissues with special reference to cell invasiveness, serotype, and trigger factor gene polymorphism.

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Propionibacterium acnes is the only microorganism so far isolated from sarcoid lesions. To examine whether P. acnes isolates from sarcoid tissues differ from those obtained from non-sarcoid tissues, we studied cell invasiveness, serotype, and polymorphisms of the P. acnes trigger factor protein and the two invasion-associated proteins (named PAmce and PAp60) in 35 P. acnes isolates from sarcoid lymph nodes and 127 isolates from non-sarcoid tissues. Most of the serotype I isolates (79/112; 71%), but none of the serotype II isolates (0/50) were cell-invasive. Two prominent types of trigger factors, one with and one without a 15 amino acid-residue deletion, corresponded to serotype II and serotype I, respectively. Non-invasive isolates had genomic mutations that caused more than one amino acid change in either the PAmce or PAp60 gene, with four exceptional isolates. P. acnes was finally classified into nine isotypes, and isolates obtained from sarcoid and non-sarcoid tissue did not differ. Although the finding did not link P. acnes to sarcoidosis, the present study clarified the cell invasiveness of P. acnes and the close correlation of cell invasiveness to the serotype and genotype of the two invasion-associated P. acnes genes.

[Nationwide survey of nuclear medicine practice and estimation of collective effective dose in Japan.].

For the estimation of collective effective dose from radiopharmaceuticals used in nuclear medicine diagnosis, a national survey was carried out in Japan. The survey contents covered radiopharmaceutical use, sex, age, activity, and so on of each patient in October 1997 and the monthly number of examinations in 1997. The annual number of diagnostic examinations using radiopharmaceuticals was 0.82 million for males and 0.74 million for females. The frequency of examination was about 3% for patients less than 17 years old and about 60% for those more than 60 years old. Effective dose was calculated on the basis of such literature as ICRP publications. The dose used most frequently was 5-6mSv per examination. The collective effective doses from diagnostic nuclear medicine examinations were estimated to be 13100 man .Sv for males and 20200 man .Sv for females.

[Survey of CT practice in Japan and collective effective dose estimation].

Computed tomography(CT) has been established as an important diagnostic tool in clinical medicine and has become a major source of medical exposure. A nationwide survey regarding CT examinations was carried out in Japan in 2000. CT units per million people in Japan numbered 87.8. The annual number of examinations was 0.1 million in those 0-14 years old, 3.54 million for those 15 years old and above, and 3.65 million in total. Eighty percent of examinations for those 0-14 years old were examinations of the head, as were 40% for those 15 years old and above. The number of examinations per 1000 population was 290. The collective effective dose was 295 x 10(3) person.Sv, and the effective dose per caput was evaluated as 2.3 mSv.