Endoscopic sinus surgery for the odontogenic maxillary cysts.

OBJECTIVE: To evaluate the effectiveness and usefulness of transnasal endoscopic surgery for the treatment of odontogenic maxillary cysts. METHODS: Between February 2003 and February 2008, transnasal endoscopic surgery was performed under general anesthesia in 13 patients (male 6 and female 7, 19 to 75 years old) with odontogenic maxillary cysts that extended to the maxillary sinus. Ten patients had a radicular cyst and three patients had a dentigerous cyst. After the resection of anterior edge of the inferior turbinate, the lateral wall of the inferior nasal meatus was opened. Then, the cyst wall of the maxillary sinus was partially or completely removed under the endoscope. RESULTS: The cyst walls were completely removed in five often patients with a radicular cyst and in all three patients with a dentigerous cyst. Five patients with a radicular cyst received partial resection of the cyst wall. The affected teeth could be preserved in seven of ten patients with a radicular cyst and in one of three patients with a dentigerous cyst. There were no complications, and postoperative courses were uneventful. Follow-up period ranged from 11 to 72 months (mean 42 months), and no recurrence has been noted in any of the cases. CONCLUSIONS: Endoscopic transnasal surgery for the odontogenic maxillary cyst is less invasive than conventional dental approach, and most of the affected teeth can be preserved. This technique appears to be a simple and highly effective surgical treatment for the treatment of patients with odontogenic cysts that extend to the maxillary sinus.

Nucleotide sequence encoding human pancreatic ribonuclease.

A cDNA coding for human pancreatic ribonuclease was isolated from a pancreas cDNA library and sequenced. This cDNA (1620 bp) includes an entire open reading frame encoding mature protein (128 aa) following a signal peptide (28 aa) as well as 5'- and 3'-untranslated regions.

Changes in structural organization of surface membrane during erythrocyte maturation.

The effect of concanavalin A and its succinylated derivative on cell agglutination and potassium compartmentation of mature and immature erythrocytes was observed. The binding of tetravalent concanavalin A to the surface glycoproteins of rabbit erythrocytes leads to a change in the properties of the surface membrane, which results in an induction of cell agglutination and concomitant release of potassium from the cells. Both of the phenomena induced by concanavalin A are temperature dependent, and observed at above 15 degrees C. Divalent succinylated concanavalin A, lacking the inducing activity of surface glycoprotein cross-linking into patches and caps, caused neither cell agglutination nor change in the potassium compartmentation of erythrocytes and reticulocytes. In the case of immature reticulocytes, however, remarkable agglutination of the cells was induced without a change in the potassium compartmentation after treatment with tetravalent concanavalin A. It is suggested that changes in the molecular organization of the surface membrane occur in which potassium compartmentation of the reticulocytes becomes more susceptible to surface glycoprotein cross-linking during cellular maturation.

Isolation and characterization of nephritogenic antigen from bovine glomerular basement membrane.

A method for isolation of a potent nephritogenic antigen from bovine glomerular basement membrane has been established; the glomerular basement membrane was solubilized by trypsin digestion and fractionated successively by gel filtration on Ultrogel AcA-34, concanavalin A affinity chromatography and affinity chromatography on immobilized antibodies. The antigen thus prepared was found to be highly nephritogenic; it causes glomerulonephritis in rats by a single injection of 0.1 mg per individual. Amino acid and carbohydrate analyses revealed that the antigen is a glycoprotein which contains amino acids and sugars characteristic of collagen, namely, hydroxyproline, hydroxylysine, glycine, glucose and galactose, although the relative amounts of these amino acids and sugars are less than those found in Type IV collagen of glomerular basement membrane.

Successful extended hypothermic cardiopulmonary preservation for heart-lung transplantation.

The inability to obtain sufficiently extended hypothermic organ preservation is a major restriction on clinical heart-lung transplantation. We used core cooling, nonrecirculating retrograde heart perfusion, and lung immersion with liposomal recombinant human superoxide dismutase in an attempt to provide effective 12-hour cardiopulmonary preservation. Donor dogs supported by cardiopulmonary bypass were rapidly cooled to 15 degrees C with cardioplegic arrest, and heterotopic heart and unilateral left lung transplantations were performed. In control dogs (n = 7), hearts and lungs, harvested after core cooling and cardioplegic arrest, were transplanted with a total mean ischemic time of 88 +/- 5 minutes. In group II (n = 7), heart-lung blocks were similarly excised but preserved at 4 degrees C for 12 hours (756 +/- 30 minutes) and then transplanted. During preservation, the lungs were immersed in hyperosmolar extracellular solution. For the heart, retrograde coronary sinus perfusion was performed with intracellular solution containing perfluorochemicals at a temperature of 4 degrees C and a rate of 30 ml/hr for 12 hours. In group III (n = 7), donor organs were similarly excised and preserved for 12 hours (726 +/- 39 minutes), except that liposomal recombinant human superoxide dismutase was administered during harvest, preservation, and reperfusion. Myocardial function, assessed by the ratio of end-systolic pressure to end-systolic dimension, after the 12-hour preservation period in both experimental groups was similar to that of the control group 4 and 6 hours after transplantation. The mean arterial oxygen capacity of the transplanted left lung during ventilation with an inspired oxygen concentration of 40% was also similar in each group. In contrast, the 12-hour preservation of pulmonary function assessed by pulmonary vascular resistance, the accumulation of extravascular lung water, and histologic evidence of alveolar wall injury, interstitial edema, and perivascular hemorrhage were significantly impaired in the absence of liposal recombinant human superoxide dismutase. These findings suggest that successful extended cardiopulmonary preservation for heart-lung transplantation is possible with core cooling, nonrecirculating retrograde heart perfusion, and hypothermic lung immersion incorporating liposomal recombinant human superoxide dismutase.

Oxygenated perfluorocarbon, recombinant human superoxide dismutase, and catalase ameliorate free radical induced myocardial injury during heart preservation and transplantation.

The effect of free radical scavengers on free radical-induced myocardial injury during heart preservation and transplantation was examined. Four groups of nine hearts each were harvested from mongrel dogs (12.5 to 16.5 kg) and orthotopically transplanted to size-matched recipients. All hearts received a continuous perfusion of oxygenated modified Collins' solution (group A). In addition, groups B, C, and D received Fluosol DA and albumin. Preservation perfusion was performed for 18 hours, at 4 degrees C, pH = 7.4, and 20 mm Hg. In group C, recombinant human superoxide dismutase (4,080 U/mg, 20 mg/kg) and bovine catalase (46,200 U/mg, 20 mg/kg) were administered only during preservation perfusion. In group D, these scavengers were administered just before and during reperfusion for 1 hour. Hemodynamic studies were performed before excision of the donor hearts and 1 hour after the termination of cardiopulmonary bypass. Creatinine kinase MB isoenzyme and thiobarbituric acid reactive substance levels in the coronary effluent were determined during preservation perfusion and reperfusion. Only group A showed a significant heart weight gain (p less than 0.05) and a decline in passive compliance (p less than 0.05) during preservation. Lactate release was higher in group A than in the groups receiving Fluosol DA. In contrast, pyruvate levels in group A were lower than in other groups. The generation of free radicals stayed at a low level during preservation, but significantly increased during reperfusion and was associated with a corresponding increase in creatinine kinase MB isoenzyme. Perfusion with a perfluorochemical solution (group B) inhibited the sharp rise in levels of thiobarbituric acid reactive substances and of creatinine kinase MB isoenzyme and improved cardiac function during reperfusion (versus group A). Exogeneous free radical scavengers administered just before and during reperfusion (group D) significantly ameliorated thiobarbituric acid reactive substances and creatinine kinase MB isoenzyme levels and also induced a significant hemodynamic improvement during reperfusion. However, administration of scavengers during preservation did not. This study demonstrates that the generation of free radicals is primarily significant during reperfusion and reoxygenation after ischemia. Thus the best time for administration of scavengers is just before and just after the onset of reperfusion. Furthermore, perfusion with perfluorochemicals effectively maintains aerobic metabolism and ameliorates free radical damage during this period.

Macromolecular charge and cellular surface charge in adhesion, ingestion, and blood vessel leakage.

To get reliable information about the role of charged groups of tissue components on the integrity of blood circulation, the staining and perfusion experiments of rat organs with cationic (cacodylate iron colloid) and anionic iron colloid (chondroitin iron colloid) particles were carried out. These cationic and anionic iron colloid particles are stable in a wide range of pH's. Dissociation curves of several tissue components at varied pH levels were observed for the analysis of the results obtained by histochemical observations and perfusion experiments. The results indicated that all the intra- and extracellular spaces of living tissues are surrounded by the ionized anionic groups. No ionized cationic groups were found except on the macrophage surface. The cationic iron colloid particles perfused into organs through vessels adhered to the endothelial cell surface inducing the swelling of the cells. The cationic particles invaded into surrounding tissues passing through the damaged endothelial layer, but plasma protein leakage did not occur being prevented by the newly formed fibrin-fibrinogen lining. The anionic iron colloid particles introduced into vessels did not adhere to blood vessel walls but were taken by reticuloendothelial cells or macrophages. The importance of the ionized anionic groups of proteins on the endothelial cell surface and surrounding tissues for the integrity of blood vessel function was stressed.

Transport of ferritin from Kupffer cells to liver parenchymal cells. Morphological and immunocytochemical observations.

In attempting to determine the pathway of ferritin from Kupffer cells to liver parenchymal cells, anionic iron colloid particles of a ferric hydroxide-potassium polyvinyl sulfate complex (Fe-PVS) were injected intravenously into blood-depleted anemic rats. After iron loading, the process of ferritin formation and the daily change in the latter's distribution in the liver were studied by ultrastructural-immunocytochemical techniques. Three days after Fe-PVS injection, a mass of reaction products of ferritin was found in Kupffer cells, though not in the sinusoidal endothelial or parenchymal cells. Four days post-Fe-PVS injection, however, reaction products in Kupffer cells disappeared, while appearing in parenchymal cells. Observations at 3.5 days after the injection revealed heavy deposition of reaction products in the sinusoid and Disse's spaces as well. Electron microscopic observation of tissue sections treated with bismuth subnitrate taken at this stage revealed diffuse dispersion of ferritin particles in the cytoplasmic matrix of parenchymal cells as well as in the sinusoid and Disse's spaces. Ferritin particles were not found in the coated pits and vesicles of the Kupffer cells and parenchymal cells. Four days after injection, ferritin particles were found in clusters in the cytoplasm of the parenchymal cells and also in their lysosomal bodies. The results indicate that ferritin synthesized in Kupffer cells is released into sinusoidal and Disse's spaces and then accumulated in parenchymal cells.

Core-cooling, heart-perfusion, lung-immersion technique provides successful cardiopulmonary preservation for heart-lung transplantation.

Mongrel dogs underwent heterotopic heart-orthotopic left lung transplantation. In Group I (N = 6), donor organs procured following core cooling to 15 degrees C on cardiopulmonary bypass (CPB) with cardioplegic arrest were immediately transplanted. In Group II (N = 6), following cardioplegic arrest without CPB core-cooling, the pulmonary artery was flushed with modified Collins' solution. Heart-lung blocks were immersed in extracellular solution for 6 hours and then transplanted. In Groups III and IV (N = 6 each), following CPB core-cooling to 15 degrees C and cardioplegic arrest, the organ blocks were immersed in extracellular solution (Group III) and the heart was perfused with oxygenated extracellular solution (Group IV). Evaluation of lung function using differences in arterial oxygen tension between the left and right atria demonstrated no differences between groups. However, extravascular lung water and pulmonary vascular resistance were significantly elevated in Group II. Cardiac function assessed by the ratio of end-systolic pressure to end-systolic dimension was significantly better in Group IV than in Groups II and III. Thus, adequate 6-hour hypothermic cardiopulmonary preservation with core cooling plus heart perfusion can be achieved for heart-lung transplantation.

Endoscopic surgery for a parathyroid functioning adenoma resection with the neck region-lifting method.

Recently, endoscopic surgery has been applied to cervical exploration. We have developed new techniques for endoscopic neck surgery. We reported on a 53-year-old Japanese man with functioning parathyroid adenoma resected by endoscopic surgery with a neck region-lifting method. A 10-mm midline trocar for the endoscope and two 5-mm lateral trocars were inserted from the anterior chest wall to avoid neck scars. There were no intraoperative complications. The incisions were completely covered by the patient's undergarments.

Degranulation effect of ferric nitrilotriacetate (Fe3+-NTA) on the pancreatic islet beta-cells: its acute toxic effect on glucose metabolism.

A single injection of ferric nitrilotriacetate (Fe3+-NTA) caused a transitory increase in plasma immunoreactive insulin (IRI) and plasma immunoreactive glucagon (IRG) in rats. They reached maximum levels at 2 days after injection and returned to the normal range at 10 days. At 2 days after Fe3+-NTA injection, blood glucose level was normal but the glucose tolerance test (GTT) was impaired. There was a further increase in plasma IRI level and IRG level was suppressed after glucose loading. At 10 days after Fe3+-NTA injection, glucose tolerance was normal and IRI also returned to the normal range. No degenerative changes were found on H.E.-stained rat pancreatic tissue sections after Fe3+-NTA injection. Histochemical staining, however, showed a reduction in beta-granules and heavy metals (Timm's granules) from islet cells in the central area of the rat pancreatic islet 1 to 3 days after injection of Fe3+-NTA. The fading remained in some islets even at 10 days after injection, but by then the beta-granule distribution was restored in most islet cells. The results indicate a single Fe3+-NTA injection induced transitory instability of the pancreatic islet beta-cell granules and the glucose intolerance with a hyperresponse of IRI.

"Pseudo-cap" formation in Ehrlich ascites tumor cells induced by cytochalasin B.

Cytochalasin B (CB) treatment induces or accelerates the capping phenomenon in some cells. In Ehrlich ascites tumor cells (EATC) CB treatment apparently induced the capping of Con A binding sites as observed under a fluorescent microscope. However, electron microscopic examinations revealed that the CB treatment did not induce a rearrangement of Con A binding sites, but rather it only induced a change in cell shape. On the contrary, CB treatment inhibited the capping phenomenon induced by treatment with Con A. Electron microscopic observations may give exact information on the distribution of lectin binding sites.

The anionic barrier of blood vessel walls and the possible pathologic changes due to the deionization of the barrier and plasma proteins.

For the purpose to observe the possible vessel wall damage by deionization of the related anionic groups the perfusion test of rat kidney and aorta with cationic iron colloid particles and the injection experiments with albumin-poly-L-lysine complex were carried out. By staining the fixed tissue sections with the cationic iron colloid at pH 7.3 the ionized anionic sites on vessel walls have been demonstrated histochemically. The perfusion test of living tissue with the cationic iron colloid induced the desquamation of the endothelial cells. The perfused colloid particles were adsorbed to the whole endothelial cell surfaces facing to luminal and subluminal sides. Albumin-poly-L-lysine complex injected into vein deposited in the subendothelial spaces of glomerular capillaries through the endothelial cell layer having the well-kept anionic barriers. Discussion was made on possible damage of vessels due to the deionization of anionic groups of endothelial cells and serum proteins by general cationic molecules.

[Spinal electrostimulation in the treatment of advanced chronic obliterating arteriopathies]. / L'elettrostimolazione spinale nel trattamento delle arteriopatie obliteranti croniche in stadio avanzato.

From 1989 to 1992 83 patients suffering from peripheral vascular disease without medical or surgical possibilities, were treated by spinal cord stimulation (SCS). We studied claudicatio intermittens, rest pain and ischemic lesion behaviour in all the patients. We also studied microcirculation behaviour of 21 patients, by oxygen transcutaneous tension (vasodilatation index VI = TcPO2 42 degrees C: TcPO2 45 degrees C) and laser Doppler flowmetry (resting flow RF, standing flow SF, venoarteriolar reflex VAR = RF - SF, flow temperature increase FTI = F 40 degrees C 15'-RF). The clinical follow-up at 2 years showed an improvement of walking distance in 85.7% of 7 controls, a complete rest pain control in 82.35% of 17 controls, an improvement and healing of ischemic lesions respectively in 27.07% and 53.86% of 18 controls. In arteriosclerotic arteriopathy with or without diabetes but without neuropathy VI increased and FTI decreased, after SCS, showing a sympathetic tone decrease. In arteriosclerotic arteriopathy with diabetic neuropathy V.I. decreased and FTI increased, after SCS, showing a sympathetic tone reappearance. VAR improved or reappeared, in arteriosclerotic arteriopathy with or without diabetes, showing improvement of tissue perfusion as regards a better efficiency of "paramicrovessels" and "microvascular unit". We believe that SCS, as regards favourable clinical results represents a useful and effective treatment in peripheral vascular disease treatment.

Intestinal mucosa and intra-abdominal lymphoid tissues of the platypus, Ornithorhynchus anatinus.

The morphological features of the intestinal mucosa and intra-abdominal lymphoid tissues of the platypus were examined. The mucosal surface of the intestine was characterized by the formation of large folds instead of the finger-like villi found in placental mammals. The lamina propria of the mucosal fold was well developed and contained numerous lymphocytes, expressing the lymphoid nature which is characteristic of the lamina propria of mammalian intestines. Although numerous well-developed Peyer's patches were observed in the ileum, solitary lymphoid nodules could not be found anywhere in the small intestine. Other intra-abdominal lymphoid tissues, particularly mesenteric lymphoid nodules, were well developed. However, each nodule represented a single follicle in contrast to the mammalian mesenteric lymph node which is composed of numerous follicles fused together. On the basis of the above findings, the tissues in question are considered to be at an evolutionary level preceding that of placental mammals.

[Intracranial hemorrhage in autopsy cases with occlusion of the circle of Willis (author's transl)].

Seventeen autopsy cases with occlusion of the circle of Willis were examined clinicopathologically. These patients ranged in age from 8 years to 64 years and consisted of 6 males and 11 females. The following results were obtained. 1. Fresh and massive intracerebral hemorrhage was confirmed in 13 of 17 patients and cerebral infarct in 4 of 17 patients. 2. Among these 13 patients, massive hemorrhage was found in basal ganglia, thalamus and hypothalamus of 9 patients, and in thalamus, cerebral peduncle and midbrain of 4 patients. 3. Rupture of the dilated muscular-type arteries was noted in the thalamus and basal ganglia in 2 of 13 patients. Ruptured arteries with organization of the lumen were found in the old hemorrhagic foci in one of them. 4. Overgrown and dilated arteries, branching off from the circle of Willis, were confirmed in 11 patients. These arteries consisted of "perforating" arteries well developed as collateral circulation. 5. No ruture in these arteries of the subarachnoidal spaces was found in 11 patients. In one of them, a small saccular aneurysm was found. These findings strongly suggest that in patients with occlusion of the circle of Willis intracerebral rupture of overgrown "perforating" arteries as collateral circulation may be the main cause of intracranial hemorrhage and intracerebral hemorrhage due to rupture of the arteries may be repeated.

[Japanese cedar pollen in house dust].

Caring for oneself against Japanese cedar pollinosis is important as well as receiving medical-care. Although the importance of avoiding pollen is described in the guideline for nasal allergy medical treatment, however, there is no information for effective dust cleaning for the home. This study examined how many cedar pollens were included in indoor dust in order to obtain basic data whether dust removal for cedar pollen is available for pollinosis suffers. As a result, the study found that there were many Japanese cedar pollens in indoor dust even before the pollen season. Cedar pollen increased with the increasing number of airborne pollen. The highest number of pollen found in one week was approximately 450 pollens in a square meter of a living room floor. The study concluded that cleaning is one of the best way to remove Japanese cedar pollens found in indoor dust.

[IFOBT-positive gastric cancer].

Among 888 patients who underwent operation or endoscopic resection for gastric cancer (1994-1998), 75 patients, who had no colorectal disease or only small polyps 5 mm or less in diameter, were positive on the immunologic fecal occult blood test (IFOBT) (the positive group). They are compared with the other 813 patients (the negative group) as to the following 6 points: symptoms, presence of anemia, depth of invasion including macroscopic appearance, location, maximum diameter of lesions, and microscopic findings. The rate of positive-IFOBT gastric cancer was 8.4%. The average blood hemoglobin concentration was significantly lower in the positive group than in the negative group. Advanced cancers, especially type 2 and 3, were significantly more frequent in the positive group than in the negative group. The size of the lesions tended to be larger in the positive group than in the negative group. There was no difference between the groups as to symptoms, location, depth of invasion and microscopic findings. In conclusion, IFOBT-positive patients who have no colorectal disease or only small polyps 5 mm or less in diameter should be recommended to undergo upper gastrointestinal endoscopy.

[High energy phosphates and mitochondrial respiratory function after 24 hours cardiac preservation--comparison between simple hypothermic immersion and continuous hypothermic perfusion].

Cardiac preservation is one of the most important step during heart transplantation. Prolonged preservation period is necessary to get the greater donor pool. To get safe prolonged preservation two methods, simple hypothermic immersion method (group A) and continuous hypothermic perfusion method (group B), were compared in this report by evaluating the myocardiac high energy phosphate level and mitochondrial respiratory function. The values of ATP, TAN and Energy charge were significantly higher in group B than group A (p less than 0.001). Mitochondrial respiratory function such as state 3 QO2, state 4 QO2, RCI and ADP/O also showed significantly higher values in group B than group A (p less than 0.001). These date indicate that continuous hypothermic perfusion method provides better preservation than simple hypothermic immersion method for 24 hours cardiac preservation.

Endoscopic resection of malignant sinonasal tumours with or without chemotherapy and radiotherapy.

OBJECTIVE: An increasing number of transnasal endoscopic surgical procedures are being performed, and these procedures are now also utilised in the management of malignant sinonasal tumours. This study aimed to evaluate the outcome of endoscopic resection of sinonasal malignancies, with or without chemotherapy and radiotherapy. METHODS: Between 2000 and 2009, six patients with sinonasal malignancies (diagnosed on pre-operative biopsy) underwent endoscopic resection at our hospital. The histopathological diagnoses varied and included squamous cell carcinoma, olfactory neuroblastoma, chordoma, extramedullary plasmacytoma and haemangiopericytoma. RESULTS: Surgical resection was combined with chemotherapy and/or radiotherapy in four cases. The mean follow-up period was 43 months. One patient suffered local recurrence of chordoma, 84 months after the first operation, but this was successfully treated with proton beam radiotherapy. CONCLUSION: These results suggest that endoscopic resection may be a valid alternative to conventional resection in selected cases of malignant sinonasal tumour.