Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis.

BACKGROUND AND PURPOSE: Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis. MATERIALS AND METHODS: This retrospective cohort study included choroidal anastomosis-positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area. RESULTS: Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], P < .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21-2.03, for every 1% increase). CONCLUSIONS: The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.

Follow-up study of bedwetting from 3 to 5 years of age.

OBJECTIVES: To evaluate the relationship between bedwetting and development in infancy. METHODS: Questionnaires concerning micturition habits and development at 3 and 5 years of age were completed by the parents of 157 children who had had their health checked by pediatricians at a group checkup at 3 years of age. RESULTS: The percentage of bedwetters in whom the frequency of bedwetting was at least once a month was 53% at 3 years of age and 21% at 5 years of age. The prevalent resolution period of bedwetting in infants was 2.5 to 3.5 years of age. The head circumference for boys at birth differed significantly between the bedwetters and nonbedwetters at both ages. Daytime symptoms were more frequent among bedwetters at both ages. Earlier toilet training had no influence on bedwetting at 5 years of age, although it led to earlier control at night at a younger age. Delays in speaking and walking might be factors connected to bedwetting. The prevalence of bedwetting in boys was higher than that in girls. Multiple logistic regression analysis revealed that daytime incontinence and sex were significant factors for bedwetting at 5 years of age. CONCLUSIONS: Daytime incontinence and sex were the significant factors for bedwetting in infancy. Head circumference for boys and developmental delays in speaking and walking might also be important factors.

Discrete regions in the laterodorsal tegmental area of the rat regulating the urinary bladder and external urethral sphincter.

In urethane anesthetized rats, the laterodorsal tegmental area was stimulated systematically with a carbon fiber electrode to clarify regions regulating the urinary bladder and/or the external urethral sphincter. Contraction of the former was monitored by bladder pressure and that of the latter by electromyogram. Stimulation of a small area around the ventrolateral edge of the central gray in a plane at the junction of the mesencephalon and pons, where cholinergic neurons in the laterodorsal tegmental nucleus formed the largest mass, induced contraction only of the bladder. Arranged in tandem rostrocaudally with this bladder site, a very small area whose stimulation induced contraction only of the sphincter was found also at the ventrolateral edge of the central gray in a plane slightly caudal to the above. Slightly lateral and caudal to this sphincter site, there were sites the stimulation of which induced contraction of both the bladder and sphincter. It was thus shown physiologically that there were discrete sites in the laterodorsal tegmental area regulating the bladder and sphincter independently.

Evaluation of reflux kidney using renal resistive index.

PURPOSE: We clarified the relationships of the renal resistive index, reflux and renal scarring. MATERIALS AND METHODS: The resistive index in the interlobar artery was measured using power Doppler ultrasonography in 22 patients with reflux (reflux group), 13 with postoperative or resolved reflux (previous reflux group) and 20 who served as controls. RESULTS: Resistive index values in 11 kidneys with mid or high grade reflux were significantly higher than in 22 with low grade reflux and in the 40 normal kidneys. The resistive index in the 11 kidneys with reflux and scarring was significantly higher than in the 22 with reflux and without scarring, and in the 40 normal kidneys. The resistive index in the 14 kidneys with previous reflux and scarring was significantly higher than in 12 with previous reflux and without scarring, and in the 40 normal kidneys. Receiver operating characteristics curve analysis in 25 kidneys with and 34 without scarring revealed that a discriminatory resistive index value of 0.71 was optimal for detecting renal scarring. When the resistive index cutoff value was 0.71, there was 76% sensitivity for diagnosing renal scarring, 91% specificity and 85% overall accuracy. CONCLUSIONS: Our results show the possibility that an increased resistive index in kidneys with reflux predicts renal scarring. The resistive index measured with power Doppler ultrasonography may be a noninvasive and useful alternative for screening and following renal scarring.

Are micturition systems influenced by sleep-arousal system?

To clarify a relation between contractile condition of the urinary bladder and vigilance condition, bladder pressure was monitored simultaneously with cortical electroencephalogram (EEG) in urethane-anesthetized rats. Slow waves of large amplitude and those of lower amplitude appeared in EEG alternately. The bladder showed no contractile activity in the former EEG condition, while it contracted intermittently or continuously to urinate in the latter EEG condition. The relative power of EEG delta waves was significantly different in these two conditions. These results suggest that activity of the micturition system changes according to vigilance conditions, which may serve to prevent enuresis during sleep.

Systematic treatment for nocturnal urinary frequency following a sleep-micturition chart.

Seven patients complaining of nocturnal urinary frequency were treated following a sleep-micturition chart. By clinical analysis of the data, the causes of nocturnal urinary frequency were divided into three diagnostic categories: a small bladder capacity group, a sleep disorder group and a large nocturnal urinary volume group. The three groups were treated by anticholinergic agents, sleeping pills and restriction of water intake at night respectively. With the administration of anti-cholinergic agents or sleeping pills nocturnal bladder capacity increased. By restriction of water intake at night nocturnal urinary volume decreased. In all patients nocturnal urinary frequency decreased and sleep efficiency was improved.

Classification based on overnight simultaneous monitoring by electroencephalography and cystometry.

OBJECTIVES: To evaluate the features of the clinical findings in three types (types I, IIa, IIb) of enuresis, classified by overnight simultaneous monitoring by electroencephalography (EEG) and cystometry (CM). METHODS: We performed a test to evaluate bladder capacity, arousal response and the pattern of nighttime urination in sucklings and infants. RESULTS: As for the values of enuretic bladder capacity (EBC), the smallest were found in enuresis type IIb. As for arousal response, enuresis type I showed the best, while enuresis type IIa showed the worst response. With regard to the pattern of nighttime urination in sucklings and infants, all sucklings had a stable bladder in the sleep state and urinated in the pattern of type IIa. The arousal response to bladder distention indicating type I appeared at the age of about 2 or 3. CONCLUSIONS: The smallest EBC in patients with enuresis type IIb represented a bladder dysfunction in the sleep period. It was observed that patients with enuresis type I had the best arousal function while those with enuresis type IIa had the worst arousal function. All sucklings urinated unconsciously during sleep in the pattern of type IIa. The arousal response to bladder distention indicating type I, which was not observed below the age of 1 year, was thought to appear at the age of about 2 or 3 years. If this change has not appeared by the age of 3, bed-wetting might persist after the age of 5.

Effects of systematic treatment based on overnight simultaneous monitoring of electroencephalography and cystometry.

OBJECTIVE: To clarify the effects of systematic treatment based on overnight simultaneous monitoring by electroencephalography (EEG) and cystometry (CM) on each type of enuresis. METHODS: For enuresis type I, the change in the awakening response during the conditioning treatment with a therapeutic machine was observed. For enuresis type IIa, the effect of imipramine on the EEG was observed. For enuresis type IIb, the effect of oxybutynin hydrochloride on the cystometrogram (CMG) was observed. RESULTS: Values, in which the awakening score on the second night was subtracted from the score on the last night, were significantly higher in the effective cases than in the unchanged cases. Out of the 3 patients in whom imipramine was effective, an awakening response on the EEG was observed in 2. Neither of the 2 unchanged cases showed an awakening response. Out of 4 patients in whom oxybutynin hydrochloride was effective, uninhibited contractions (UIC) on the CMG disappeared in 3. UIC stopped in neither of the 2 unchanged cases. CONCLUSIONS: Improvement of the awakening response plays an important role in the effectiveness of conditioning treatment with our therapeutic machine. The generation of awakening response is thought to be the most important result of imipramine directly concerned with its clinical effect on enuresis type IIa. The main result with oxybutynin hydrochloride in enuresis type IIb is thought to be related to its antispasmodic effect.

Cross-linking of egg white riboflavin-binding protein by calcium phosphate.

No larger molecular weight component appeared in the high-performance gel chromatogram when calcium alone was added to the riboflavin-binding protein solution (RfBP), indicating that calcium alone did not aggregate it. RfBP bound calcium, but the amount of bound calcium decreased markedly upon dephosphorylation. Cross-linked RfBP, which was detected by high-performance gel chromatography using simulated milk ultrafiltrate as the effluent, was formed when calcium and phosphate were added. Cross-linking of RfBP was confirmed by ultracentrifugal analysis. RfBP was found to be cross-linked through its phosphate groups, since no cross-linked fraction was detected when calcium and phosphate were added to a dephosphorylated RfBP solution. RfBP cross-linked by calcium phosphate formed at 12-20 mM calcium, 13-17 mM phosphate, and 10 mM citrate was a dimer, since its retention time was consistent with that of the dimer cross-linked by glyceraldehyde. The physiological function of phosphate groups of RfBP was also discussed.

The concepts, procedures, and problems related in endoscopic laser therapy of early gastric cancer. A retrospective study on early gastric cancer.

We report 34 cases of early gastric cancer in which endoscopic laser therapy was performed at the Kitasato University Hospital. The problems encountered were the size and location of the tumor, the presence of lymphatic metastasis or concomitant disorders, and technical problems associated with the irradiation procedure. Of the 34 cases, 22 cases were considered as completely cured (no malignancy was detected after laser therapy), 11 cases were incompletely cured (malignant cells were detected after laser therapy), and 1 case was undetermined.

Salivary urea nitrogen as an index to renal function: a test-strip method.

To investigate the feasibility of using salivary urea nitrogen as an index of renal glomerular filtration rate, we developed and applied a new analytical system consisting of a urease-containing test strip and an automatic reflectance spectrometer. The concentrations of urea nitrogen so determined correlate well (r = 0.93) with concentrations in serum. These preliminary data suggest that our method can be used routinely as a simple and reliable means of detecting abnormalities of renal function.