Therapeutic results of the modified Cadenat procedure for acromioclavicular joint separations compared with the modified Dewar procedure.

AIM AND BACKGROUND: The surgical treatment for acromioclavicular joint dislocations is recommended for Rockwood's classification types 4, 5 and 6. In this study we evaluate the therapeutic results of the modified Cadenat procedure on type 5 acromioclavicular joint dislocation, and report on a comparative study of the modified Dewar procedure also on type 5 acromioclavicular joint dislocation. SUBJECTS AND METHODS: The modified Cadenat procedure was performed on 73 patients (66 males and 7 females, group C). The mean age at the time of the surgery was 35.4 years. On the other hand, the modified Dewar procedure was performed on 55 patients (51 males and 4 females, group D). The mean age at the time of the surgery was 34.5 years. RESULTS: The mean therapeutic results were 28.2 points in group C and 27.3 in group D according to the UCLA scoring system. In group C, the subluxation that represented less than 5 mm superior translation of the clavicle, occurred only in 18 of 73 patients. Meanwhile, in group D, the subluxation that represented less than 5 mm, occurred only in 14; that which represented 5 to 10 mm was in seven patients, and the complete dislocation occurred in three patients. Also, the occurrence of osteoarthritic changes in the acromioclavicular joint was nine patients in group C and 20 in group D, respectively. CONCLUSION: The modified Cadenat procedure could provide satisfactory therapeutic results and avoid postoperative failure of reduction compared to the modified Dewar procedure. However the modified Cadenat procedure does not aim to restore the anatomical coracoclavicular ligaments. It is believed that anatomic restoration of both coracoclavicular ligaments could best restore the function of the acromioclavicular joint.

Design of microfluidic channels to prevent negative filtration in implantable hemofiltration devices.

In order to improve the quality of life of dialysis patients, our group have been developing an implantable hemofiltration device (IHFD) composed of multiple layers of dialysis membranes and microfluidic channels. To improve the hemodialysis performance of IHFD, preventing the negative filtration, which is caused by the oncotic pressure of blood, is mandatory. In this study, we fabricated IHFDs with five different microchannel designs and experimentally investigated the performance of each device in in vitro experiment. In addition, the successful IHFD was further evaluated by ex vivo experiments with a beagle dog. The experiments verified the effectiveness of the microchannel design, which will be used for the IHFD for in vivo experiments with pigs in the future.

Ultrasonic measurement of melanosomes for characterization of their physicochemical structure in B16 and Harding-Passey melanomas.

Ultrasonic measurement of the two different forms of melanosomes was carried out at 20 to 300 MHz on B16 and Harding-Passey mouse melanomas which produce ellipsoidal-lamellar and spherical-granular melanosomes, respectively. We found that the structure of the two forms is basically amorphous and copolymeric in the molecular dimension of a segment composed of 5 to 6 zigzag units. A marked difference in particle wave resonance was found around 200 MHz in the two melanosomes. Based on the chemical structure of melanin proposed by Hempel, it was indicated that the physical structure of Harding-Passey melanosomes is a copolymer in which melanin and protein moieties run parallel to each other but may bind together at the sites of planar groups, while that of B16 melanosomes is a double-helix polymer of melanin and protein moieties with a screw symmetry of N = 6. This type of one-dimensional cyclic ordering, commonly known as the Born-Karman periodic boundary condition in semiconductive band theory, may be related to the formation of the lamellar structure seen in B16 melanosomes.

Biometric confirmation of the Hirschberg ratio in strabismic children.

PURPOSE: In the Hirschberg eye position test, the ratio of strabismic angle to decentration of the corneal reflex is dependent on two biometric parameters of the eye: the radius of the corneal curvature and the depth of the anterior chamber. This study was designed to confirm whether the Hirschberg conversion ratio (HR) previously determined for adults can be used for children of various ages despite structural growth of the eye. METHODS: For 262 eyes of 131 children with strabismus (age range, 6 months to 11 years), the radius of the corneal curvature was measured with an auto-keratometer and the anterior chamber depth with an A-scan ultrasound unit under general anesthesia before the surgery. Using these measurements, the HR was computed on the basis of a geometric model. RESULTS: The calculated HR was constant across the age range, and the mean+/-SD was 19.9+/-1.9 prism diopters/mm (95% confidence interval, 16.1-23.6 prism diopters/mm). The ratios for the two eyes in each subject showed good correlation (R = 0.854, P = 0.0001). Neither of the biometric measurements was significantly correlated with age, although considerable scatter of the measurements was observed. CONCLUSIONS: These results indicate that the averaged HR can be applied in children regardless of the patient's age, although intersubject variance of the ratio should be taken into account.

Prism adaptation response is useful for predicting surgical outcome in selected types of intermittent exotropia.

PURPOSE: To evaluate the prevalence of prism adaptation response in Japanese patients with intermittent exotropia (X [T]) using the prism adaptation test and to assess whether patients with selected types of X [T] benefit from surgical outcome to which prism adaptation response may contribute. METHODS: In a prospective study, 128 consecutive patients with X [T] between 1990 and 1995 were enrolled. The prism adaptation test was conducted by neutralizing the angle of deviation for 2 to 3 hours. Patients who showed an increase in exodeviation by 10triangle up or more with the prism adaptation test were defined as having a prism adaptation response. For classification of the pattern of X [T], we chose a value of 15triangle up as the difference between the distance and near measurements. RESULTS: The percentage of patients in whom the prism adaptation response was observed at near fixation was significantly larger than those at distance fixation [35 (27%) patients versus 10 (8%) patients, P <.05]. Of 35 patients shown to have a prism adaptation response at near fixation, 21 patients (83%) had the basic type of exotropia. Fourteen patients (17%) with the basic type were changed to convergence insufficiency type because of an increase in near deviation and were defined as pseudo basic type. Patients with pseudo basic type had a significantly better surgical outcome compared with that of true basic type, whereas in the convergence insufficiency type, no definite tendency was found between the two subtypes, true and pseudo types. CONCLUSION: Patients with the pseudo basic type of X [T] in whom a prism adaptation response was demonstrated had a more favorable surgical outcome.

Correction of cyclovertical strabismus induced by limited macular translocation in a case of age-related macular degeneration.

PURPOSE: To report a case of strabismus surgery performed to treat cyclovertical strabismus induced by limited macular translocation. METHODS: Case report. RESULTS: A 62-year-old man suffering with age-related macular degeneration and subfoveal choroidal neovascularization, RE, underwent limited macular translocation surgery. The fovea was rotated downward, and his visual acuity improved from 20/100 to 20/25 postoperatively. Cyclovertical diplopia persisted for 6 months after the operation. A Hess screen test revealed a pattern that simulated an underaction of the superior oblique muscle and inferior rectus muscle with an overaction of the ipsilateral inferior oblique muscle. To treat the diplopia, advancement of the superior oblique muscle tendon and resection of the ipsilateral inferior rectus muscle were performed. Binocular single vision with 140 seconds of arc for stereopsis was obtained. CONCLUSION: Cyclovertical strabismus after limited macular translocation is corrective with conventional surgery on the treated eye.

Large Bielschowsky head-tilt phenomenon and inconspicuous vertical deviation in the diagnostic positions in congenital superior oblique palsy.

PURPOSE: To report a case of congenital superior oblique palsy with an unusually large Bielschowsky head-tilt phenomenon (BHP) and disproportional inconspicuous vertical deviation. METHODS: Case report. RESULTS: An 18-year-old woman presented with slight compensatory head tilting and a Bielschowsky head-tilt phenomenon of 50 Delta on left tilting. Magnetic resonance imaging revealed atrophy of the left superior oblique muscle. A Hess screen test showed a slight underaction of the left superior oblique muscle, but neither an obvious overaction of the ipsilateral inferior oblique muscle nor inhibitory palsy of the contralateral superior rectus muscle was found. With a 3-mm recession of the ipsilateral superior rectus muscle, Bielschowsky head-tilt phenomenon decreased to 25 Delta. CONCLUSION: A large Bielschowsky head-tilt phenomenon was possibly caused by an increased gain of the otolith-ocular reflex affecting the vertical rectus muscle.

Inhibitory effects of acetylcholine on aggressive-defense reaction induced by electrical stimulation of the hypothalamus in cats.

The effects of ventral amygdalofugal pathways (VAF) or stria terminalis (ST) on the hypothalamic aggressive-defense (rage) reaction were examined in fifteen cats. After bilateral electrolytic lesions of the VAF or ST, 0.5 pmol of acetylcholine (ACh) was injected into the VMH and electrical stimulation was applied. The changes in the threshold for range reaction were compared in the non-lesioned, VAF-lesioned and ST-lesioned group. Both VAF-lesioned and non-lesioned cats showed a similar degree of significant elevation in the threshold for rage at 5 min after injection, while ST-lesioned group had no significant elevation. These results suggest that the ST is concerned with the elevation of threshold for rage due to ACh injection.

Characteristics and variability of vertical phoria adaptation in normal adults.

We evaluated the characteristics of phoria adaptation for vertically induced retinal disparity. An adaptive change in the fusion-free ocular alignment, phoria adaptation, was measured with a computer-aided mirror haploscope at 10, 30, and 60 minutes after the start of wearing of a 3-prism-diopter base up prism by 35 normal subjects ranging in age from 21 to 67 years (mean: 37 years). The relationships between phoria adaptation and the subjects' age, the vertical fusional amplitude, the amount of heterophoria, and the starting time of the examination were evaluated. All subjects showed phoria adaptation, with the mean (+/- SD) degree of 0.78 +/- 0.28 degree, 0.96 +/- 0.26 degree and 1.02 +/- 0.30 degrees at 10, 30, and 60 minutes, respectively, after wearing the prism. The repeatability (95% confidence interval) for the measurements was less than +/- 0.24 degree. There was a significant correlation between the vertical fusional amplitude and the gain of phoria adaptation (at 10 and 60 minutes, P < 0.05). The gain of phoria adaptation measured at 60 minutes showed a significant decrease with age (P < 0.01). The results indicate that the time course of phoria adaptation in the vertical direction is similar to that in the horizontal direction and its gain differs considerably among subjects.

Induction of unseasonable hibernation and involvement of serotonin in entrance into and maintenance of its hibernation of chipmunks T. asiaticus.

Chipmunks that had been housed at 22 degrees C under a light-dark cycle of 14L:10D for at least one year were exposed to a short photoperiod (10L:14D) and low temperature to induce unseasonable hibernation. We were able to induce hibernation at any time of year and there was no significant difference in the duration of the hibernation bout, the duration of interbout euthermia and duration of bouts of torpor throughout the year; however entrance into hibernation took about 60 days in summer but only about 30 days in any other seasons. In addition, interbout euthermia predominantly occurred during the light phase in winter, whereas in spring interbout euthermia occurred equally in the light and dark phases. These results suggest that both the circadian and circannual systems are linked to hibernation in chipmunks. Subcutaneous infusion of a serotonin antagonist, para-chlorophenylalanine (PCPA), facilitated entrance into and interrupted hibernation in aroused and hibernating chipmunks in summer, respectively. On the other hand, opioid antagonist, naloxone, did not affect hibernation, but extended the period of interbout euthermia. These results suggest that the role of serotonin in entrance into and maintenance of hibernation in chipmunks is independent of the circannual system, and that opioid system may not be involved in hibernation in chipmunks.

[Hyperhomocysteinemia in CAPD patients: peritoneal transport of total homocysteine at peritoneal equilibration test and daily elimination of total homocysteine].

Peritoneal equilibration tests (PET) were performed in patients on continuous ambulatory and automated peritoneal dialysis (CAPD, APD) to evaluate the peritoneal transport capabilities for total homocysteine (tHcy) and other amino acids. Forty-five patients (24 males, 21 females, 50.6 +/- 12.8 years old) maintained on PD for 43.4 +/- 30.3 months participated in the study. PET revealed a markedly lower dialysate to plasma (D/P) ratio of tHcy at 4 hours (0.148 +/- 0.047) than those of other amino acids. A significant positive correlation between the D/P ratio of tHcy and the D/P ratio of creatinine was found, as well as between the D/P ratio of tHcy and the D/P ratio of albumin. The most significant positive correlation was found between dialysate and plasma levels of tHcy at 4 hours. There was no difference in the D/P ratio of tHcy between patients with D/P ratios of creatinine higher than the sample median of 0.68 and with D/P ratios of creatinine below 0.68, while the D/P ratios of other amino acids except threonine in the former patients tended to be higher than those of the latter patients. The D/P ratio of tHcy in patients with serum levels of albumin higher than 4.0 g/dl was significantly higher than that in patients with a ratio less than the sample median of 3.9 g/dl, whereas there were no significant differences in the D/P ratios of other amino acids. These observations suggest that the dialysate level of tHcy is primarily affected by the plasma level of tHcy, and that protein-bound Hcy mainly regulates the D/P ratio of tHcy. Daily peritoneal elimination of tHcy in 20 PD patients was 40.6 +/- 28.4 micromol. A significant positive correlation between the elimination of tHcy and plasma level of tHcy was also found. Daily elimination of tHcy in 7 patients with APD tended to be lower than that in 13 patients with CAPD. These findings indicate that the daily peritoneal elimination of tHcy does not compensate for the daily amount of tHcy metabolized in normal kidney, and that other therapies, such as folic acid administration, are required to improve hyperhomocysteinemia in patients on PD.