Red ear syndrome presenting with vestibular migraine: case study and review of the literature.

BACKGROUND: Red ear syndrome is a rare disorder in which the colour of the ear suddenly becomes red, with discomfort, pain and a burning sensation. This paper reports a case of primary red ear syndrome presenting with vestibular migraine. CASE REPORT: A 39-year-old woman from Bangladesh reported dizziness and repeated headaches experienced since 18 years of age. She initially attended our hospital with dizziness aged 34 years. When dizzy, the colour of her right ear sometimes became red. Therefore, she was diagnosed with red ear syndrome with vestibular migraine. CONCLUSION: This patient experienced repeated episodes of a red ear with discomfort, leading to the diagnosis of red ear syndrome. In addition, she had repeated dizziness and headaches, and was also diagnosed with vestibular migraine. The diagnosis of red ear syndrome with vestibular migraine should be considered in cases of dizziness and headache with recurrent redness of the ear.

Optofluidic tweezer on a chip.

A novel method to realize an optical tweezer involving optofluidic operation in a microchannel is proposed. To manipulate the optical tweezer, light from an optical fiber is passed through both PDMS (polydimethylsiloxane)-air surface lenses and an optofluidic region, which is located in a control channel. Two liquids with different refractive indices (RIs) are introduced into the control channel to form two different flow patterns (i.e., laminar and segmented flows), depending on the liquid compositions, the channel geometry, and the flow rates. By altering the shapes of the interface of the two liquids in the optofluidic region, we can continuously or intermittently control the optical paths of the light. To demonstrate the functionality of the proposed method, optical tweezer operations on a chip are performed. Changing the flow pattern of two liquids with different RIs in the optofluidic region results in successful trapping of a 25 µm diameter microsphere and its displacement by 15 µm.

The out-patient management of patients with acute mild-to-moderate colonic diverticulitis.

BACKGROUND: There are no management criteria for optimum out-patient care in mild-to-moderate acute colonic diverticulitis. AIM: To enable such patients to be managed in an out-patient setting, by establishing criteria and treatment protocols. METHODS: We conducted an open trial and follow-up study from 1997 to 2002. On the basis of ultrasonography, we defined and categorized mild-to-moderate acute colonic diverticulitis ranging from limited inflammation within diverticulum to an abscess < 2 cm in diameter. Subjects were treated as out-patients and followed a 10-day treatment protocol consisting of an oral antibiotic and a sports drink for the first 3 days. Physical examination and laboratory testing helped determine whether or not a patient could resume a liquid diet on day 4, and a regular diet on day 7. RESULTS: Of the 70 patients, 68 were successfully treated. Two patients required hospitalization. Of the 65 patients who were tracked over several months [median (intraquarter range) = 30.8 (11.9-44.2) months], 16 had one or more clinical recurrences. The medical cost per episode was 80% lower than in-patient treatment. CONCLUSIONS: Patients with mild-to-moderate acute colonic diverticulitis can be safely and successfully treated as out-patients using this protocol.

Measures for preventing recurrence after pterygium surgery.

PURPOSE: To introduce an improved technique of pterygium surgery and to compare postoperative results between this technique and previous techniques. METHODS: In a retrospective survey, the records of 216 consecutive eyes with primary pterygium that underwent surgery by three different techniques were reviewed. The new technique (mini-flap technique) involves making a small excision of the pterygium body, removing the pterygium head by scraping with forceps, applying mitomycin C (MMC), and performing a small conjunctival transposition flap. The previous technique (large-flap technique II) involved making a large excision in the pterygium body, removing the pterygium head with a knife, applying MMC, and performing a large transposition flap. Large-flap technique I is the same as large-flap technique II except for the use of intraoperative MMC. The recurrence rate of each technique was estimated by the Kaplan-Meier life table analysis. RESULTS: The recurrence rates estimated at 1 year after surgery were 15.5% in large-flap technique I, 4.2% in large-flap technique II, and 0% in the mini-flap technique. Large-flap technique II or the mini-flap technique had significantly lower recurrence rates compared with large-flap technique I ( p = 0.02 and p < 0.01, respectively). The mini-flap technique had a significantly lower incidence of conjunctival scarring or granuloma compared with large-flap technique I and large-flap technique II ( p = 0.05 and p = 0.03, respectively.) CONCLUSIONS: The mini-flap technique was useful for preventing recurrence and was technically easier and induced fewer postoperative complications than large-flap techniques I and II.

Clinical application of full-arc, depth-dependent, astigmatic keratotomy.

PURPOSE: To report a case series of the first clinical application of a new method of astigmatic keratotomy termed full-arc, depth-dependent astigmatic keratotomy (FDAK). METHODS: The type of astigmatism was analyzed by corneal topography. If the astigmatism was regular, paired arcuate incisions of 90 degrees length were used. Incision depth varied between 40% and 75% of local corneal thickness for controlling the level of astigmatic correction. RESULTS: All 13 cases had regular astigmatism, and paired arcuate incisions of 90 degrees length were used. Four cases with incisions at 40% depth, five cases at 50% depth, three cases at 60% depth, and one case at 75% depth induced vector astigmatic change of 0.93 +/- 0.33 D, 1.92 +/- 0.24 D, 3.17 +/- 0.26 D, and 4.44 D, respectively, 3 months after surgery. From 3 months to 1 year or 3 years, the postoperative astigmatism was stable, and no cases showed astigmatic regression of 0.50 D or more. Every topographic difference map indicated effective flattening and steepening occurring with a 1:1 coupling ratio. All postoperative color maps showed a marked improvement in corneal sphericity. CONCLUSIONS: In FDAK using paired 90 degrees incisions at 40-75% depth, an almost linear relationship between the incision depth and degree of astigmatic change was observed. FDAK may be an effective and safe method of astigmatic keratotomy that accurately controls the level of astigmatic correction. More clinical applications are necessary for drawing final conclusions and making a nomogram.

Role of Atp7b gene in spontaneous and N-diethylnitrosamine-induced carcinogenesis in a new congenic strain, WKAH.C-Atp7b rats.

To examine whether Long-Evans Cinnamon (LEC) rats, a mutant rat model of Wilson's disease, have a susceptibility gene(s) to hepatocarcinogenesis in addition to the causative gene, Atp7b, we established a new congenic strain, WKAH.C-Atp7b rats, in which the Atp7b gene of the LEC rats is inserted into the normal Wistar-King Aptekman Hokkaido (WKAH) background. Hepatocellular tumors developed spontaneously in both sexes of WKAH.C-Atp7b rats, their incidence being slightly lower than that in LEC rats. Incidences of spontaneous liver tumors in LEC, WKAH.C-Atp7b and WKAH rats correlated with hepatic copper and iron concentrations. Medium-term liver bioassay showed that LEC rats were more susceptible to the induction of glutathione S-transferase placental form-positive preneoplastic foci than WKAH.C-Atp7b rats, and WKAH.C-Atp7b rats were more susceptible than WKAH rats. In an N-diethylnitrosamine (DEN)-induced long-term carcinogenicity study, 1) LEC rats were similarly or rather less susceptible to hepatocellular tumors than WKAH.C-Atp7b and WKAH rats, indicating that the progression of the preneoplastic foci to liver cancer in LEC rats was worse than that in WKAH.C-Atp7b and WKAH rats, 2) the incidences of kidney tumors in LEC and WKAH.C-Atp7b rats were higher than that in WKAH rats and high copper concentrations in the kidneys were observed in LEC and WKAH.C-Atp7b rats, 3) LEC rats were resistant to lung carcinogenesis. These data indicate that the susceptibility of LEC rats to liver and kidney carcinogenesis could be explained by Atp7b gene mutation and that the susceptibility to lung carcinogenesis is controlled by gene(s) other than Atp7b.

Management of posterior capsule rupture during phacoemulsification using the dry technique.

To manage posterior capsule rupture during phacoemulsification, we use a dry technique in which all procedures are performed without an irrigation/aspiration system. The dry technique is characterized by (1) continuous viscoelastic injection instead of fluid irrigation to maintain anterior chamber depth with the posterior capsule and vitreous located posteriorly and (2) static removal of most residual lens material by viscoexpression and/or manual small incision extracapsular cataract extraction without aspiration and dynamic water flow. In 16 cases of posterior capsule rupture managed using the dry technique, the residual nucleus and cortex were readily removed with minimum extension of the ruptured area and new vitreous loss. Although large amounts of viscoelastic material (mean 5.8 mL) were required, rapid and stable visual recovery was comparable to that in patients having uneventful surgery. The dry system is a safe and reliable technique for managing posterior capsule rupture during phacoemulsification.

A possible role for BDNF, NT-4 and TrkB in the spinal cord and muscle of rat subjected to mechanical overload, bupivacaine injection and axotomy.

Neurotrophins play a crucial role in the regulation of survival and the maintenance of specific functions for various populations of neurons. Neurotrophin-4 (NT-4) is most abundant in skeletal muscle, and is thought to promote sciatic nerve sprouting, inhibit agrin-induced acetylcholine receptor (AChR) clustering, evoke postsynaptic potentiation and induce mitochondrial proliferation. Using Western blot analysis, immunoprecipitation and immunohistochemistry, we investigated the distribution of NT-4 in slow- and fast-type muscles. We also tested the adaptive response of this protein in the mechanically overloaded muscle, in the regenerating muscle following bupivacaine injection and in the denervated muscle. Additionally, we investigated whether TrkB phosphorylation in the spinal cord and in the sciatic nerve occurs through the interaction with BDNF or NT-4 when the innervating muscle is damaged. Markedly more NT-4 was expressed in fast-type muscles compared with the slow types. TrkB protein was more frequently observed around the edge of myofibers (neuromuscular junction) of the soleus muscle compared with the gastrocnemius muscle. TrkB tyrosine phosphorylation occurred in the spinal cord but not in the sciatic nerve 24 h after bupivacaine injection of the innervating muscle. At the same time, the amount of TrkB co-precipitating with BDNF was markedly increased in the spinal cord. A rapid activation of TrkB (1-8 h) was also observed in the spinal cord after axotomy,while the amount of TrkB co-precipitating with NT-4 was markedly lower after axotomy. These results indicate that NT-4 is preferentially distributed in fast-type muscles. Furthermore, by interacting with BDNF and NT-4, the TrkB in the spinal cord may be important for the survival of motoneurons and outgrowth of injured peripheral axons following muscle damage.

Experimental study using pig eyes for realizing ideal astigmatic keratotomy.

PURPOSE: The effects of varying the incision length and depth were analyzed using pig eyes to acquire information for realizing an ideal method of astigmatic keratotomy (AK). METHODS: Single and paired arcuate incisions were made on pig corneas using a diamond knife. Incisions with varying lengths of 40 degrees, 60 degrees, and 90 degrees were made with the incision depth fixed at 90% of corneal thickness. Next, paired incisions with varying incision depth from 20% to 95% of corneal thickness were made with the incision length fixed at 90 degrees. The changes in corneal shape were analyzed using corneal topography and the degrees of astigmatic change were measured using a surgical keratometer. RESULTS: For short single and paired incisions (40 degrees or 60 degrees in length), narrow areas of flattenings occurred, and steepenings were observed on both sides adjacent to the flattened areas. For long paired incisions of 90 degrees length, wide areas of flattenings and steepenings were observed with an approximately 1:1 coupling ratio, and a positive linear relationship between the incision depth and degree of astigmatic change was observed in the range of incision depth between 40% and 80% of corneal thickness. CONCLUSION: This experimental study suggests that for achieving ideal corneal sphericity after AK, long incisions covering the entire steep areas (paired 90 degrees incisions for regular astigmatism) should be used and the degree of astigmatic correction may be controlled by varying the incision depth.

Extra-anatomic bypass graft for management of axillary artery occlusion in pitchers.

OBJECTIVE: Our goal was to evaluate the long-term results of vein bypass grafts for axillary artery occlusion, specifically those placed extra-anatomically to prevent arterial injury in pitchers. METHODS: With the greater saphenous veins used as the selected conduit, arterial bypass grafts were routed anterior to the pectoralis minor muscle in four baseball pitchers who had occlusion of the axillary artery. We performed a follow-up in excess of 10 years with evaluations of the bypass grafts by ultrasonic duplex scan and magnetic resonance angiography. RESULTS: All four pitchers treated in this manner returned to the game and played for several seasons without a recurrence of the arterial injury. Long-term evaluation of the bypass grafts did not reveal any structural or functional disorder. CONCLUSIONS: Axillary artery occlusion in an athlete can be effectively treated with a vein bypass graft placed extra-anatomically, anterior to the pectoralis minor muscle. The greater saphenous vein should be considered the conduit of choice.

Guided knives.

A new type of knife that enables a surgeon to easily create tunnel-shaped incisions with a prescribed depth has been developed. The knife features an incision guide, the arm of which extends just beyond the tip of the blade. The space between the blade and the arm can be set at the desired width. By moving the knife as if sliding the arm across the corneal or scleral surface, the blade can move to a certain depth from the surface. The guided knife enables even novice surgeons to easily make a self-sealing incision during cataract surgery. In addition, the innovative nature of this device seems to be applicable to many other surgeries that require a partial-thickness incision.

Effect of temperature on the frequency of chromosome aberrations and micronuclei in cultured Chinese hamster cells.

We previously reported that both hyperthermia and hypothermia induced micronuclei in mouse bone marrow cells (Asanami and Shimono, 1997a, 1997b, 1999). To investigate the effects of temperature on chromosome aberration in vitro, we conducted chromosome aberration and micronucleus tests under hyper- and hypothermic conditions using Chinese hamster lung (CHL) cells. In the chromosome aberration test, we observed positive responses at 40 degrees C and 41 degrees C for 24 hr, and at 42 degrees C for 6 hr and over. In the micronucleus test, we observed positive responses at 31 degrees C, 33 degrees C, and 40 degrees C for 24 hr, and at 42 degrees C for 2 hr. The results suggest that in CHL cells, hypothermic conditions can induce micronuclei while hyperthermic conditions can induce both chromosome aberrations and micronuclei.

Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions.

PURPOSE: To evaluate the results of a modified self-sealing incision for achieving astigmatic neutrality in cataract surgery requiring a 6.0 to 7.0 mm incision as well as the methods of correcting preexisting astigmatism using these incisions. SETTING: Department of Ophthalmology, Kushimoto Rehabilitation Center, Kushimoto, Japan. METHODS: To achieve astigmatic neutrality, a frown-shaped, oblique incision-the BENT (between 9 and 12 o'clock) frown-was used. To reduce preexisting against-the-rule or with-the-rule astigmatism, the incisions were placed on the temporal or superior steep astigmatic axis, respectively. A frown incision was used when aiming for mild astigmatic reduction and an arcuate incision when aiming for relatively large astigmatic reduction. RESULTS: In the 6.0 to 7.0 mm BENT frown incision group, mean flattening was minimal throughout 6 months of follow-up, with a maximum of 0.18 diopter (D) 1 week postoperatively. Surgically induced astigmatism was less than that with other incisions. Ninety-four percent of cases had a difference in absolute astigmatism of less than 0.50 D between preoperatively and 6 months postoperatively. Relatively large flattening was observed in eyes with 6.0 to 7.0 mm steep-axis incisions of superior arcuate, temporal arcuate, superior frown, and temporal frown, with means of 1.03, 0.79, 0.64, and 0.52 D, respectively, at 6 months. Ninety-eight percent of cases had a reduction in preexisting absolute astigmatism postoperatively. CONCLUSIONS: In cataract surgery using relatively large scleral self-sealing incisions, the BENT frown incision effectively achieved astigmatic neutrality. The incisions on the temporal or superior steep astigmatic axis (with selective shape) reduced astigmatism in almost all cases.

Quarters extraction technique for manual phacofragmentation(1).

In the quarters extraction technique, the nucleus is manually split and the fragments then removed. A 5.5 to 6.5 mm sclerocorneal single-plane incision is made. After capsulorhexis, hydrodissection, hydrodelineation, and surface cortex aspiration, the edge of the nucleus is prolapsed into the anterior chamber. The front quarter of the nucleus is cut and removed with a nucleus puncher. A corner of the remaining three quarters of nucleus is wedged into the wound and rotated out with a claw vectis. Among the initial 120 cases, there were no posterior capsule ruptures, and the mean endothelial cell loss at 3 months was 8.7% +/- 6.5% (SD). Because there is no need to deeply insert instruments at the time of nuclear fragmentation, this technique can be performed safely and easily in most cases except in eyes with very large nuclei.

Production of three distinct mRNAs of 150 kDa oxygen-regulated protein (ORP150) by alternative promoters: preferential induction of one species under stress conditions.

150 kDa oxygen-regulated protein (ORP150) is one of the endoplasmic reticulum (ER)-resident stress proteins. We have cloned and sequenced the entire human ORP150 gene covering over 15-kb. Analyses of transcription initiation sites and transcriptional regulatory sequences revealed that at least three distinct mRNA species were produced by alternative promoters: two of them starting from alternative exon 1 (1A or 1B), and the third one starting from exon 2, six nucleotides upstream of the first AUG initiation codon. Among them, the transcript that begins with exon 1B was preferentially induced by hypoxia or tunicamycin treatment. A cis-acting segment involved in the stress-dependent induction was found at the 5'-end of exon 1A, which could account for the selective induction of the transcription from exon 1B. Furthermore, in vitro analyses of translation of the third mRNA suggested the constitutive expression of the cytosolic ORP150 due to the lack of the signal peptide resulting from differential translation initiation.

Manual sutureless cataract surgery using a claw vectis.

Two-handed sandwich methods of extracapsular cataract extraction using a self-sealing incision have proved difficult for many inexperienced surgeons. We developed a simpler 1-handed technique using a claw vectis-a vectis with a claw placed on its tip. When the nucleus is pulled through the scleral tunnel, it is fixed by the claw and is smoothly removed from a wound of a size comparable to that in the sandwich method. During nucleus removal, viscoelastic material is constantly injected through the irrigation vectis to maintain the anterior chamber depth, resulting in a low incidence of complications. We have performed 620 cases using the technique and found it safe and easy for both novice and experienced surgeons.

Changes in dopamine transporter and c-Fos expression in the nucleus accumbens of alcohol-tolerant rats.

BACKGROUND: We have shown that neurochemical functions of 5-HT3 receptors in regulating dopamine (DA) release in the nucleus accumbens (ACC) after alcohol exposure compensate for the dysfunction of serotonergic activity to restore the original properties in processing alcohol tolerance, and that the development of alcohol dependence may be mediated by ACC 5-HT3 receptors. In the present study, the effects of chronic alcohol consumption on the functions of the dopamine transporter (DAT) and the expression of c-Fos proteins were investigated using in vivo brain microdialysis and immunocytochemistry. METHODS: Perfusion of cocaine and 1-(2-Bis-(4-fluorophenyl) methoxy) ethyl)-4-(3-phenylpropyl) piperizine (GBR 12909) through the microdialysis probe membrane increased the extracellular levels of DA in ACC of alcohol-treated rats that had developed alcohol tolerance by drinking 10% EtOH for 30 days. RESULTS: The magnitudes of DA reuptake or DAT inhibitors, cocaine, and GBR 12909 that induced DA availability in the ACC were significantly higher in alcohol-treated rats than in controls. When compared with control rats, the alcohol-treated rats exhibited higher levels of DA and its metabolite, DOPAC, in the ACC. Increased expression of the c-Fos-like protein was found in the ACC of alcohol-treated rats. These results show that (1) chronic alcohol consumption desensitizes or decreases the DAT of DA terminals in the ACC and that (2) EtOH causes cellular hyperexcitability of ACC dopaminergic neurons with increased Fos expression during alcohol tolerance. CONCLUSION: The findings suggested that an abnormality of the dopaminergic neurons in the ACC that are involved with DAT dysfunction is associated with the development of alcohol tolerance.

A new concept for the correction of astigmatism: full-arc, depth-dependent astigmatic keratotomy.

OBJECTIVE: The purpose of this study is to introduce and evaluate a new concept in astigmatic keratotomy (AK) named full-arc, depth-dependent AK (FDAK). DESIGN: Noncomparative interventional case series. PARTICIPANTS: FDAK was performed on a total of 37 eyes with regular astigmatism; of these, 16 eyes received FDAK alone, and 21 eyes received FDAK combined with cataract surgery. METHODS: Corneal topography was used to divide the cornea into two discreet regions of "steep" and "flat." Then, paired arcuate incisions, 90 degrees in length, were placed along the full arc of the steep area. The level of astigmatic correction was controlled by varying the incision depth from 40% to 80% on the basis of a provisional nomogram developed by the authors. MAIN OUTCOME MEASURES: Keratometries, corneal topographies, and visual acuities were measured. RESULTS: The FDAK alone group showed a significant improvement from a preoperative corneal astigmatism of 2.90 +/- 0.78 diopters (D) to a postoperative value of 0.89 +/- 0.52 D. The "combined" group also showed significant improvement from a preoperative corneal astigmatism of 2.97 +/- 1.01 D, to a postoperative value of 1.02 +/- 0.45 D. The deviation of achieved correction from attempted correction using vector analysis was between 1.37 D of undercorrection and 0.98 D of overcorrection, with 91.9% of cases within the range of +/- 1.0 D. Slight oblique change caused by axis deviation was observed in seven cases. Both uncorrected and corrected visual acuity showed statistically significant improvement. No serious complications were encountered. CONCLUSIONS: Controlling the level of correction by varying the incision depth allowed the surgeon to use long incisions (90 degrees in length in regular astigmatism) covering the entire steep area, minimizing the undesirable changes induced by conventional deep and narrow incision AK and resulting in an ideal corneal sphericity after surgery. FDAK enabled the surgeon to accurately control the level of astigmatic correction with minimal risk of corneal perforation.

Defective DNA replication and repair associated with decreases in deoxyribonucleotide pools in a mouse cell mutant with thermolabile ubiquitin-activating enzyme E1.

Upon shift-up in temperature, mouse tsFS20 mutant cells with thermolabile ubiquitin-activating enzyme E1 immediately stopped DNA replication and showed cell cycle arrest in S-phase. In contrast, when the cells were permeabilized with lysolecithin after culture at the nonpermissive temperature, they exhibited a normal level of replicative DNA synthesis in vitro. In agreement with this, intracellular pools of deoxyribonucleoside triphosphates were significantly reduced in the cells cultured at the nonpermissive temperature. Even under the permissive conditions, tsFS20 cells were more sensitive to hydroxyurea and alkylating agents, and induced less mutation than the wild-type cells. These results suggest that the ubiquitin system affects DNA replication and repair.