Functional analyses of the stratum corneum in scars. Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars.

OBJECTIVE: To characterize the functional properties of the stratum corneum (SC) of various scars. DESIGN: A prospective cohort study. SETTING: University hospital medical center. PATIENTS: Thirty-two consecutive patients surgically treated for various skin diseases and 26 consecutive patients with hypertrophic scars or keloids. MAIN OUTCOME MEASURES: Noninvasive bioengineering measurements of functional properties of the SC, such as transepidermal water loss (TEWL), high-frequency conductance, and SC turnover time. RESULTS: The SC barrier function assessed by TEWL was found to be a better parameter for the functional evaluation of scars than the hydration state of the skin surface measured by high-frequency conductometry. In general, the SC on the scars of deeper wounds in the dermis took longer to normalize functionally than the SC on the scars of superficial wounds, especially on the high compared with the abdomen. Thus, elevated levels of TEWL observed on scars at the donor sites of split-thickness grafts normalized between 200 and 400 days in contrast to fewer than 50 days for those of subepidermal erosions. Both TEWL and high-frequency conductance remained high in hypertrophic scars and keloids, and the SC involved showed a faster turnover time than that of adjacent normal skin. CONCLUSIONS: Scars, a proliferative change of the dermis, can be objectively evaluated according to functional abnormalities of the SC, because the dermis has a close relationship with the epidermis and with the SC. The functional characteristics of the SC of fresh scars and those of hypertrophic scars and keloids resemble those of retinoid-treated skin, rather than those found in epidermal hyperproliferative conditions such as psoriasis and dermatitis.

Frequency of anesthetic cardiac arrest and death in the operating room at a single general hospital over a 30-year period.

STUDY OBJECTIVES: To determine the anesthetic cardiac arrest (CA) and death rates in the operating room (OR) and to determine whether anesthetic CA and death are preventable. DESIGN: Prospective study. SETTING: OR suite of a general teaching hospital. PATIENTS: 85,708 patients undergoing surgery over a 30-year period. MEASUREMENTS AND MAIN RESULTS: Anesthetic CAs and deaths were identified, their causes and preventability were determined on the day of occurrence, and they were recorded over the years 1962 to 1992. Four anesthetic CAs (0.5 arrest per 10,000 anesthetics) and 1 death (0.1 death per 10,000 anesthetics) occurred during the 30-year study period. CONCLUSIONS: The results of 30 years' experience do not support the hypothesis that all anesthetic CAs and deaths are preventable. However, careful clinical management can reduce their frequency to a level lower than those reported in the referenced literature.

Intracerebral cystic meningioma--case report.

A 46-year-old female presented with persistent bifrontal headache. Computed tomography revealed a large cystic tumor in the right temporoparietal area, which included a solid component. The tumor had no attachment to the dura. There was no peritumoral edema or mass effect usually found around cystic meningiomas. The solid component was totally removed. Histological examination indicated that the tumor was a fibrous meningioma. Intracerebral meningioma with a large cystic component without dural attachment should be considered in the differential diagnosis of cystic cerebral tumors.

[Proposal of a standard method for clinical evaluation of antimicrobial agents in prostatitis--specifications of patients and criteria for evaluation of clinical efficacy].

The criteria for clinical evaluation of the efficacy of antimicrobial agents on prostatitis were proposed. Nomenclatural definition, specifications of patients and criteria were as follows. Acute prostatitis: Target infection is acute bacterial prostatitis with no underlying condition in urinary tract. The findings of swelling and tenderness of prostate by rectal examination are essential. The patients are between 16 and 69 years old. They have fever greater than 37 degrees C and pain on micturition. Microscopic examination reveals white blood cells (WBCs) in VB1 or VB2 before treatment greater than or equal to 10 cells/hpf. Viable bacteria in VB1 or VB2 before treatment are greater than or equal to 10(4) bacteria/ml. Period of treatment is for 7 days. To evaluate clinical efficacy, 3 days after administration, changes of symptoms (fever and pain on micturition) are recorded. Seven days after administration, changes of symptoms, microscopic examinations and number of bacteria are recorded. The overall clinical efficacy is graded as "excellent", "moderate" or "poor" by combining changes in the above 3 parameters. Chronic prostatitis: Target infection is chronic bacterial prostatitis with no underlying condition in urinary tract. The patients are between 16 and 69 years old. Microscopic examination reveals WBC in EPS or VB3 before treatment greater than or equal to 10 cells/hpf. Viable bacteria before treatment are greater than or equal to 10(3)/ml (GNR) or greater than or equal to 10(4)/ml (GPC). Treatment period is for 14 days. To evaluate clinical efficacy, after 14 days of administration, changes of symptoms, microscopic examinations and number of bacteria are recorded. The overall clinical efficacy is graded as "excellent", "moderate", or "poor" by combining the changes in the 2 parameters, microscopic examination and number of bacteria.

[Anesthetic management of a pediatric patient with non-Fukuyama type congenital muscular dystrophy].

Non-Fukuyama type congenital muscular dystrophy (n-FCMD), a subtype of progressive muscular dystrophy (PMD), is a very rare autosomal recessive disorder. N-FCMD is characterized by severe and progressive motor weakness and atrophies of proximal muscles during the infant period. A 9-year-old boy with n-FCMD underwent elective surgery for muscle release around the hip joints bilaterally. As many perioperative complications related with volatile anesthetics and muscle relaxants had been reported in the anesthetic management of PMD, these drugs were thought to be contraindicated in patients with n-FCMD. Because n-FCMD seemed to have very similar pathogenesis with PMD, caudal epidural block was chosen, supplemented with the administration of diazepam, pentazocine and nitrous oxide. The operation and anesthesia were conducted uneventfully. No complications occurred postoperatively.

[Spinal anesthesia for patients with progressive muscular dystrophy].

Spinal anesthesia was applied on 8 occasions to 7 patients with progressive muscular dystrophy (PMD) undergoing orthopedic lower limb surgery. No postoperative complication occurred in all patients. During the operations, however, two patients were subjected to high spinal anesthesia, which caused ventilatory suppression in one patient and bronchial asthma attack in another. Both respiratory complications were easily managed by ventilatory assistance with endotracheal intubation or by administration of bronchodilator, respectively. High spinal anesthesia should be avoided in applying spinal anesthesia to patients with PMD.

[Anesthetic management of a patient with Coffin-Lowry syndrome].

Coffin-Lowry syndrome (CLS) is characterized by mental retardation, a peculiar face and deformities of the thorax and spine. A 33-year-old female with Coffin-Lowry syndrome (CLS), further complicated with atrial septal defect and ventricular tachycardia, underwent elective surgery for anterior cervical cyst. As difficult intubation had been anticipated, anesthesia was induced with continuous administration of propofol. After confirming that she could be ventilated by mask, vecuronium bromide, midazolam and fentanyl were given. The operation and anesthesia were conducted uneventfully. No complications occurred postoperatively. The use of propofol for slow induction of anesthesia was advantageous for hemodynamic stability in this case.

[Antagonism of diazepam-induced sedative effects by flumazenil in patients after surgery under lumbar spinal or epidural anesthesia].

The efficacy and general safety of flumazenil (YM684), a specific benzodiazepine antagonist, have been evaluated. Forty-seven patients scheduled for surgery under lumbar spinal or epidural anesthesia with diazepam sedation received flumazenil at the end of the procedure. Criteria of efficacy were the degree of sedation and antegrade amnesia. Before injection all patients were heavily sedated with the mean dose of 27 mg of diazepam (range 10-50 mg). After the mean dose of 0.21 mg of flumazenil (range 0.2-0.4 mg), all patients were awake or drowsy within 1-6 min but sedation recurred in one patient 1 hour later. The amnesia was eliminated by flumazenil in 34 patients (72%). No serious side-effects or hemodynamic changes were observed after flumazenil. It is concluded that flumazenil is an effective antagonist of sedation induced by diazepam.

[Application of modified ultrafiltration to cardiac surgery in adults].

Modified Ultrafiltration (MUF) was developed for blood concentration and reduction of postoperative edema in cardiac surgery in children. Its beneficial effects on postoperative hemodynamics have been reported. We applied MUF to cardiac surgery in adults and evaluated its usefulness. Between August, 1995 and April, 1997, MUF was performed in 41 adult patients. MUF was carried out immediately after the cessation of cardiopulmonary bypass. The mean fluid volume removed was 1,135.9 +/- 274.1 ml. The patient's haematocrit significantly increased from 23.2 +/- 2.6% to 26.9 +/- 3.2% (p < 0.0001). The dose of inotropes administered was maintained constant during MUF, and no changes were observed in CVP and the heart rate. However, the systolic blood pressure increased from 99.5 +/- 14.7 to 113.2 +/- 16.2 mmHg (p < 0.0001) and cardiac index from 4.2 +/- 0.9 to 4.9 +/- 1.3 l/min/m2 (p = 0.0006). It was suggested that MUF was an useful technique of haemoconcentration and appeared to have beneficial effects on postoperative hemodynamics in adult cardiac surgery.

Platelet transfusion for surgery in the presence of polycythemia vera.

Surgery in the presence of uncontrolled polycythemia vera is associated with a high incidence of perioperative hemorrhage and postoperative venous thromboses. Control prior to surgery reduces the frequency of perioperative complications. A 73-year-old women suffering from polycythemia vera was scheduled for subtotal gastrectomy. Her platelet count before surgery was slightly elevated but bleeding time was prolonged. To manage the current case of polycythemia vera, hydroxyurea was effective for the control of hematocrit and transfusion of platelet concentrates was effective for hemostasis.

Coexistence of multiple perifollicular fibromas and colonic polyp and cancer.

Perifollicular fibroma (PFF) is a rare cutaneous hamartoma that shows differentiation to the connective tissue sheath of the hair follicle. It may be solitary or multiple; the latter has been suggested to exhibit autosomal dominant inheritance and association with colonic polyposis. We report a 72-year-old Japanese female with multiple PFF on the face, possibly familial, who developed colon cancer in addition to colonic polyps.

Growth of human keratinocytes in a defined medium supplemented with growth factor of serum.

In order to prepare a good medium for cultivation of keratinocytes, bovine serum was fractionated by precipitation with various concentrations of ammonium sulfate. The fractionated serum proteins were added to the basal medium at a concentration of 3 mg/ml. The best proliferation was observed in the medium supplemented with the 55-70% ammonium sulfate precipitated fraction. No growth of keratinocytes was observed when the medium was supplemented with the 0-35% fraction. The growth promotion by the 55-70% fraction was completely inhibited by the 0-35% fraction. These results have shown that the fractionation of serum protein clearly separated the growth-inhibitory factors and the growth-stimulating factors.

High-frequency conductance measurement of the skin surface hydration state of dry skin using a new probe studded with needle-form electrodes (MT-8C).

BACKGROUND/AIMS: When high-frequency conductance measurements are performed on dry scaly skin such as atopic xerosis, senile xerosis or psoriasis, the values recorded with a flat surfaced ordinary probe tend to be lower, indicating a reduced hydration state, than the actual one, because the rough and firm skin surface prevents close contact with the hard and flat surface of the applied probe. METHODS: We evaluated the usefulness of an MT-8C probe (Measurement Technologies Cincinnati, USA), whose skin-attaching portion is studded with 8 needle-like electrodes instead of a flat surfaced type, for measurments on dry skin. RESULTS/CONCLUSIONS: The MT-8C probe yielded conductance values slightly higher than those recorded with the flat surfaced probe attached to Skicon in measuring the hydration state of moderately dry skin surface such as atopic xerosis and senile xerosis. It seems to be comparable or more sensitive than the capacitance recording with the Corneometer. The recorded values obtained with the MT-8C probe showed more variations than the latter because of its higher sensitivity and much smaller contact area, that makes it difficult to touch to the same spots repeatedly. No such a difference was observed on severely dry skin and thickly scaly psoriatic lesions.

Basal cell carcinoma showing connections with epidermal cysts.

Basal cell carcinomas arising from epidermal cysts are rare. A 76-year-old Japanese man had had a blackish nodule on his right knee for 15 years, under which he later noticed the development of a subcutaneous nodule. On histological examination masses of tumour cells showed the feature of adenoid and solid patterns of basal cell carcinoma that were connected to the wall of epidermal cysts in many places as well as with the overlying epidermis.

Effects of silicone gel sheet on the stratum corneum hydration.

Various groups have reported the efficacy of treatment with topical silicone gel sheet (SGS) for keloids and hypertrophic scars. Because its hydrating effect on the stratum corneum (SC) has been suggested as a mechanism underlying its therapeutic effectiveness, we evaluated it by comparing it with simple plastic film occlusion. With biophysical instruments we assessed the water content of the skin surface as well as its water evaporation on the flexor aspects of bilateral forearms of 10 healthy volunteers for 30min after removal of dressings of SGS or a plastic film that were applied either for 1 day or for 7 days. Occlusion with SGS or plastic film induced hydration of the skin surface, which was followed by an initial quick and later slow process of dehydration when the skin was exposed to the ambient atmosphere. The magnitude of the increase in hydration induced by SGS was always smaller than that of the plastic film occlusion and, unlike the latter treatment, hydration became less with repetition of SGS treatment. On day 7, the SC hydration quickly reduced to the level of non-treated control skin after removal of the dressings. An in vivo test demonstrated that the water-holding capacity of the SC normalised after 7 days of SGS treatment. SGS probably produces a favourable condition for the skin by protecting it from various environmental stimuli, while keeping the SC in an adequately but not over-hydrated condition.

Effective production of anti-tetanus toxoid and anti-HBsAg human monoclonal antibodies by serum-free culture of hybridomas.

Two hybridoma systems, mouse.human-human (m.h-h) heterohybridoma and human-human (h-h) hybridoma, have been established, and hybridomas secreting anti-tetanus toxoid and anti-HBsAg human monoclonal antibodies (MoAbs), both having a neutralizing activity have been obtained. Cell-line improvement was shown to be an efficient method for improving the productivity in a cell culture process. Two kinds of serum-free media, GFS (a serum substitute)-containing media and polyethylene glycol (PEG)-containing media, have been established to produce human MoAbs. m.h-h Heterohybridomas could be cultivated for a long period by perfusion culture in an agitation vessel, but h-h hybridomas could not. We found that h-h hybridomas show growth-associated antibody production kinetics and established two kinds of long-term cultivation systems: continuous perfusion culture and semi-continuous immobilized perfusion culture. We also scaled up batch culture and short-term perfusion culture to 200-L and 50-L fermentors, respectively. Processes for large-scale purification from the culture supernatants of both GFS- and PEG-containing serum-free media have also been developed.

Effective production of anti-tetanus toxoid and anti-HBsAg human monoclonal antibodies by serum-free culture of hybridomas.

Two hybridoma systems, mouse·human-human (m·h-h) heterohybridoma and human-human (h-h) hybridoma, have been established, and hybridomas secreting anti-tetanus toxoid and anti-HBsAg human monoclonal antibodies (MoAbs), both having a neutralizing activity have been obtained. Cell-line improvement was shown to be an efficient method for improving the productivity in a cell culture process. Two kinds of serum-free media, GFS (a serum substitute)-containing media and polyethylene glycol (PEG)-containing media, have been established to produce human MoAbs. m·h-h Heterohybridomas could be cultivated for a long period by perfusion culture in an agitation vessel, but h-h hybridomas could not. We found that h-h hybridomas show growth-associated antibody production kinetics and established two kinds of long-term cultivation systems: continuous perfusion culture and semicontinuous immobilized perfusion culture. We also scaled up batch culture and short-term perfusion culture to 200-L and 50-L fermentors, respectively. Processes for large-scale purification from the culture supernatants of both GFS- and PEG-containing serum-free media have also been developed.