Polychromator for the edge Thomson scattering system in ITER.

A new type polychromator has been designed for the edge Thomson scattering system in ITER. Signal light is parallelly dispersed into two parts at the first interference filter. Spectral transmissivities for some spectral channels may enhance better than the conventional type polychromator. In the new type polychromator, the misalignment due to the machine accuracy is expected to be within the margin of APD area. In order to calibrate the spectral transmissivity using the dual-laser injection method during the plasma discharge, it is preferred that the spectral channels are separated at the geometric mean of the injected two wavelengths.

Large colorectal adenomas. An approach to pathologic evaluation.

Adenomatous polyps are common neoplastic lesions of the large intestine. The risk of carcinoma increases with polyp size. Small polyps are typically totally embedded for histologic examination, but no standard method for sampling large, grossly benign polyps has been established. We reviewed grossly noninvasive adenomas 2.5 cm or larger to determine the percentage that contained high-grade dysplasia (HGD) and invasive cancer (IC). Based on these findings, we suggest an approach to evaluating large adenomas. Forty-three colon resections met the inclusion criteria (no previous diagnosis of cancer, no gross evidence of invasion, and totally embedded polyp). Twelve (28%) had HGD with 3% (1 of 33 slides) to 100% (4 of 4 slides) containing HGD. Five (12%) had IC with 4% (3 of 72 slides) to 42% (5 of 12 slides) containing IC. All cases with IC had HGD in other slides. Probability studies showed that in the majority of cases, polyps would need to be entirely embedded to have an estimated probability of 95% or more of detecting either HGD or IC. Therefore, grossly noninvasive adenomas should be routinely entirely embedded.

Immediate prediction of recovery of consciousness after cardiac arrest.

OBJECTIVE: Short-latency somatosensory evoked potential (SSEP) monitoring has been reported to be useful in predicting neurological outcome in patients with cardiac arrest and hypoxic-ischemic encephalopathy. To obtain the immediate data of SSEP and evaluate the relationship between the presence of cortical activity and the recovery of consciousness, SSEP was recorded immediately after return of spontaneous circulation. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university general hospital. PATIENTS: The study included 30 patients resuscitated from out-of-hospital cardiac arrest. INTERVENTIONS: Basic and advanced cardiac life support, and intensive care. MEASUREMENTS AND RESULTS: SSEP were recorded between 40 and 170 min (median 65) after spontaneous circulation returned. In the initial study all 30 patients showed the Erb's point potential and the N11-13 component, while only 12 (40%) showed cortical activity. Patients were assessed neurologically for recovery of consciousness until 1 month after cardiac arrest. Of 12 these patients 8 recovered consciousness within 10 days, while all patients without cortical activity died without opening their eyes. CONCLUSION: Even immediately following resuscitation, absence of cortical activity in SSEP indicates unlikelihood of recovering consciousness, while the preservation of such activity suggests that consciousness is improved. The result promises further accumulation of patients to validate the predictive ability of SSEP in managing postresuscitated patients.

Measurements of cortical cellular pH by intracranial tonometer in severe head injury.

OBJECTIVE: To evaluate the cortical cellular damage in acute severe head injury, we measured the cortical cellular pH by using an intracranial tonometer made in our institution. DESIGN: Prospective, 3.5-yr data collection. SETTING: University hospital trauma intensive care unit. PATIENTS: Severely head-injured patients (n = 29) with Glasgow Coma Scale score <8. INTERVENTION: Routine emergency neurologic procedure. MEASUREMENTS AND MAIN RESULTS: We made 98 measurements of cortical cellular pH by intracranial tonometer in 29 severely head-injured patients in the acute phase. Each patient's intracranial pressure was recorded, and in 16 patients, the saturation of jugular venous oxygen was monitored. The outcome at 6 months after injury was significantly better in patients having a cortical cellular pH of >7.2 than those with <7.2. The cerebral perfusion pressure and cortical cellular pH correlated significantly (p < .0001). CONCLUSIONS: Our study suggests the usefulness of measurement of cortical cellular pH by intracranial tonometer for evaluating the severity of focal anaerobic cerebral metabolism and predicting patient prognosis.

Transcatheter arterial embolization for postpartum massive hemorrhage: a case report.

A 29-year-old woman suffered uncontrollable massive hemorrhage from a deep vaginal laceration following spontaneous vaginal delivery. Pelvic angiography revealed extravasation from a branch of the right pudendal artery. Transcatheter arterial embolization was successfully performed and quickly achieved hemostasis. When postpartum hemorrhage cannot be controlled with conservative treatment, transcatheter arterial embolization should be considered in order to avoid major surgery in an unstable patient and to maintain reproductive potential.

The ratio of interleukin-6 to interleukin-10 correlates with severity in patients with chest and abdominal trauma.

To evaluate the relation between proinflammatory cytokines and antiinflammatory cytokines after major trauma, we measured pro-inflammatory cytokine (interleukin [IL]-6) and antiinflammatory cytokine (IL-10) concentrations after trauma, and evaluated the relationship between the ratio of IL-6 to IL-10 and injury severity. In 20 patients who sustained chest and abdominal trauma, IL-10, IL-6, and lactate concentrations were measured at 0, 1, 2, and 4 days. The Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the ratio of IL-6 to IL-10 were calculated. IL-6, IL-10, and lactate concentrations were 197.2+/-28.4 (mean +/- SEM), 71.1+/-10.1 pg/mL, and 46.7+/-9.4 mg/dL at entry. These concentrations were significantly decreased at day 4. The ratio of IL-6 to IL-10 was 3.11+/-0.47 at entry and was significantly correlated with ISS (r=.872, P<.01), APACHE II score (r=.887, P<.01). The IL-10, IL-6, and lactate concentrations were elevated immediately after major trauma, and the ratio of IL-6 to IL-10 was correlated with injury severity. This suggests that the ratio of IL-6 to IL-10 may be used to predict the injury severity after trauma.

Strangulation of small bowel due to Meckel diverticulum: CT findings.

We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.

Change in the ratio of interleukin-6 to interleukin-10 predicts a poor outcome in patients with systemic inflammatory response syndrome.

OBJECTIVE: To examine whether changes in interleukin (IL)-6 and IL-10 concentrations in patients with systemic inflammatory response syndrome (SIRS) can predict a poor outcome. DESIGN: Prospective study. SETTING: Emergency and intensive care unit of a medical school hospital. PATIENTS: Twenty-five patients who fulfilled the criteria for SIRS. INTERVENTIONS: Blood samples were collected for cytokine determinations. MEASUREMENTS AND MAIN RESULTS: IL-6 and IL-10 concentrations were measured by enzyme-linked immunosorbent assay in plasma samples. Blood samples were obtained at 0, 1, 2, and 4 days from patients who fulfilled the criteria for SIRS. Of 25 patients, 19 survived and the other six patients died of multiple organ failure. Although IL-6 and IL-10 concentrations in survivors decreased gradually from 186.1 +/- 34.4 to 93.6 +/- 18.9 (SEM) pg/mL (p < .05) and from 77.4 +/- 21.2 to 32.0 +/- 11.8 pg/mL (p < .05), IL-6 concentrations in nonsurvivors did not. Although the ratio of IL-6 to IL-10 in survivors was almost stable, the ratio in nonsurvivors increased from 5.5 +/- 3.1 to 18.7 +/- 2.8 (p < .05). Multivariate analysis showed that when heart rate, mean arterial pressure, IL-6, IL-10, and the ratio of IL-6 to IL-10 were taken into account, there only remained a relationship between the ratio of IL-6 to IL-10 and outcome. CONCLUSIONS: In nonsurvivors, IL-6 concentrations did not decrease, IL-10 concentration decreased, and the ratio of IL-6 to IL-10 increased. An increase in the ratio of IL-6 to IL-10 indicated a correlation with a poor outcome.

Acute traumatic injury of the distal descending aorta associated with thoracic spine injury.

A rare case of traumatic injury of the distal descending aorta associated with thoracic spine injury is reported. A 21-year-old man was admitted after a traffic accident. Thoracic CT and angiography demonstrated a false aneurysm of the distal descending aorta and a compression fracture of the eleventh thoracic vertebra. At emergency surgery, a transverse linear tear at the level of the aortic hiatus was confirmed and repaired.

Open coring-out (function-preserving) technique for low fistulas.

PURPOSE: Fistula operations can be very destructive to the anal sphincters; functional abnormalities occur easily after such surgery (even with an internal spincterotomy, minor incontinence occurs), hence, function-preserving operations are best. A low fistula goes through the thin sphincter muscle layer, making it more difficult to preserve than a deeper fistula. In 1984, we developed a technique to treat long string-type low fistulas showing heavy inflammation and induration from the internal opening to the primary focus, namely, the infected intersphincteric anal gland. This report shows the main surgical techniques used. TECHNICAL METHOD: For the fistula procedure, we developed an "open coring-out" technique in which the whole fistula is pulled out, making the inside and outside clearly visible. The portion from the internal opening to the primary focus is easily opened (fistulotomy), and the primary focus is excised by coring-out (fistulectomy). For the repair procedure, the sphincter muscle edges are fixed to the underlying tissues with two kinds of sutures. The cored portion is provided with adequate drainage and two sutures that narrow and prevent pocket formation. RESULTS: Since 1984, 319 of 5,055 patients with low fistulas have been treated using this technique, and 52 patients required postoperative treatment; delayed healing occurred in 48 patients; recurrence occurred in 4 patients. Of patients responding to our survey, 16 (6.4 percent) reported postoperative complaints. Delayed healing has always been a major problem. Because the repair procedure inhibits pocket formation and allows for adequate drainage of the cored portion, cases of delayed healing have been reduced to approximately 7 percent in the last four years. CONCLUSION: This technique, which is continually being improved and evaluated, is simple, has a low risk of infection, preserves functions, and prevents deformity of the anal verge and perineum.

Suppression of autoimmune disease and of massive lymphadenopathy in MRL/Mp-lpr/lpr mice lacking tyrosine kinase Fyn (p59fyn).

MRL/Mp-lpr/lpr (MRL/lpr) mice suffer from a generalized autoimmune disease that includes autoantibody production and glomerulonephritis and develop massive lymphadenopathy characterized by an expanded population of CD4- CD8- B220+ T cells that is derived from autoreactive T cells in the periphery. Some of us previously reported that these atypical T cells overexpressed a gene for tyrosine kinase p59fyn (Fyn). To define the role of Fyn in the renal disease and lymphadenopathy in MRL/lpr mice, we have generated Fyn-deficient MRL/lpr mice whose fyn gene is replaced by the gene for beta-galactosidase. Fyn-deficient MRL/lpr mice developed markedly limited disease and lived more than twice as long as the conventional MRL/lpr mice. In the mutant mice, the production of IgG3 anti-DNA autoantibody was significantly (p < 0.005%) reduced, and glomerular deposits of IgG3 and C3 were remarkably diminished. Ag receptor-mediated proliferative responses of Fyn-deficient splenic T cells were markedly impaired. The mutant mice showed delayed accumulation of the atypical CD4- CD8- B220+ T cells that exhibited a significantly lower activity of ZAP-70 compared with those in the conventional MRL/lpr mice. These data demonstrated that Fyn is involved as a positive regulator in the disease of MRL/lpr mice. Fyn provides a signal for both the expansion of autoreactive T cells and the production of IgG3 anti-DNA autoantibody by B cells. Thus, manipulation of Fyn may improve systemic autoimmune disease in humans.

Cytologic study of the tissue repair cells of the uterine cervix. With special reference to their origin.

In order to characterize tissue repair cells (TR) of the uterine cervix and clarify their origin, exfoliated cells obtained after laser conization for early cervical lesions were examined. One specimen was first examined by Papanicolaou staining and then examined for epithelial membrane antigen (EMA) and vimentin by immunocytochemical staining, using a restaining method. The other specimen was observed by phosphotungstic acid-hematoxylin (PTAH) staining. Morphologic findings on TR were investigated together with the histologic findings on the wound healing process. TR were classified morphologically into three groups: stromal (STR), epithelial (ETR) and of unknown origin (UTR). Validity of this classification was confirmed by the findings of immunocytochemical staining with EMA and vimentin. These cells appeared one to eight weeks after laser conization. TR with relatively large nuclei, or atypical TR (ATR), appeared when each type of TR was most plentiful, at two to five weeks. Regarding the origins of each TR, cytologic and histologic findings could be considered to offer evidence that ETR originated with hyperplasia of immature cells of the squamous epithelium or reserve cells below the columnar epithelium. The presence of myofibrils in cytoplasm, demonstrated by PTAH staining for STR and some UTR, strongly suggested the possibility that these cells were myofibroblasts in granulation tissue.

Significance of magnetic resonance imaging in acute head injury.

One hundred seventy-seven patients who had incurred head trauma were studied with magnetic resonance imaging (MRI). Patients varied from those with mild injury without any focal neurological deficit to those with severe injury with post-traumatic coma. Altogether, 177 lesions were demonstrated by MRI in 123 of 177 patients within 3 days of injury using T2-weighted (SE2000/40,2000/111) and T1-weighted (IR1500/500/40) multislice sequences. In contrast, computerized tomography (CT) demonstrated 103 lesions in 90 patients. MRI was superior to CT in the diagnosis of nonhemorrhagic contusions demonstrated as a high-intensity area on T2-weighted imaging. MRI provided some information to evaluate the severity of diffuse axonal injury or to predict delayed traumatic intracerebral hematoma (DTICH).

Mechanical, electrical and cyclic nucleotide responses to peptide VIP and inhibitory nerve stimulation in rat stomach.

1. Effects of apamin on electrical and mechanical activities and cyclic nucleotide accumulation in response to vasoactive intestinal peptide (VIP) and intramural nerve stimulation were investigated in isolated circular strips of the rat stomach in the presence of atropine and guanethidine. 2. Circular muscles generated rhythmic contractions and slow waves in the antrum but not in the fundus. Intramural nerve stimulation and VIP caused frequency- and dose-dependent relaxation of fundic strips and inhibition of spontaneous contractions of antral strips. Apamin partly reduced the responses to intramural nerve stimulation but not those to VIP. 3. In the antrum, apamin reduced inhibitory junction potentials (IJPs) evoked at the nadir of slow waves but not at their zenith. In the fundus, apamin partly decreased the amplitude of IJPs. Repetitive nerve stimulation was associated with an apamin-sensitive hyperpolarization and apamin-resistant decrease in the slow wave amplitude in the antrum. 4. VIP caused a dose-dependent hyperpolarization of fundic circular muscle membrane. In the antrum, VIP inhibited spike potentials superimposed on slow waves and it decreased the slow wave amplitude in about half of the preparations. These electrical responses to VIP were resistant to apamin. 5. Intramural nerve stimulation evoked an apamin-resistant output of VIP from muscle strips, which no longer occurred after tetrodotoxin or removal of extracellular Ca2+. 6. Intramural nerve stimulation and VIP elicited apamin-resistant increases in cyclic AMP and cyclic GMP accumulations. The effects of VIP on cyclic AMP were greater than those on cyclic GMP. The effects of intramural nerve stimulation on cyclic GMP were faster in onset than those of cyclic AMP. 7. It is suggested that VIP is a neurotransmitter of the intramural inhibitory nerves concerned in the apamin-resistant relaxation of the rat stomach.

Patent omphalomesenteric duct: a case report and review of Japanese literature.

Patent omphalomesenteric duct (umbilical enteric fistula) was diagnosed in a 7-day-old infant. The duct closed spontaneously, but at the age of 4 months the infant was readmitted for a resection of the duct. A review of the literature disclosed that 65 cases of patent omphalomesenteric duct have been reported in Japan. The male/female ratio was 2.8:1. Ten out of 36 infants (27.8%) were premature. Surgery was performed in as many patients as possible--55 out of 59 cases (93.2%). The ducts averaged 3.8 cm in length and 1.1 cm in diameter. Errant gastric mucosa was found in 3 out of 30 cases (10.0%). Prolapse of the ileum was present in 28 out of 53 patients (52.8%)--a relatively high incidence. Ten out of 55 patients died (18.2%); 8 of these had a prolapse of the ileum. In view of the high mortality rate of patients with a prolapse of the ileum and the strong possibility of intestinal obstruction, patent omphalomesenteric ducts should be resected surgically.

Moderately proteinuric IgA nephropathy: prognostic prediction of individual clinical courses and steroid therapy in progressive cases.

Eighteen of 60 patients with persistent moderate proteinuria between 1.0 and 2.0 g/day and a long-term follow-up of more than 4 years received steroid therapy for a mean period of 18 months. Fifteen of these 18 patients maintained their initial creatinine clearance (CCr) of 70 ml/min or more. The remaining 42 received antithrombocyte drugs and/or nonsteroidal anti-inflammatory drugs, with 31 of them keeping their initial Ccr values of 70 ml/min or more. All 14 cases with initial Ccr values of less than 70 ml/min in both the steroid and nonsteroid groups followed progressive courses, with 12 ending up in hemodialysis. Of the nonsteroid, preserved group of 31 cases, 12 followed a stable course, 10 a progressive course, and the other 9 went into end-stage renal failure necessitating hemodialysis. There were no differences in initial clinical features among these three subgroups. But histological changes were milder in the stable subgroup than in the progressive and hemodialysis subgroups. Further, the total score of eight histological parameters was 6 or less in all but 1 of the cases of the stable subgroup, but 8 or higher in the other two subgroups. Therefore, in the progressive cases alone with initial Ccr values of 70 ml/min or more and high total scores of 7 or more, the long-term clinical courses were compared between steroid and nonsteroid groups (10 and 20 cases, respectively). In the steroid group proteinuria decreased significantly and renal function was preserved well as compared with that in the nonsteroid group.(ABSTRACT TRUNCATED AT 250 WORDS)

Production of monoclonal antibody against Aeromonas hydrophila haemolysin.

Two hybridoma cell lines that produce monoclonal antibodies against Aeromonas hydrophila haemolysin were established by fusion of myeloma and spleen cells obtained from a mouse immunised with haemolysin detoxified with tetranitromethane. Enzyme-linked immunosorbent assay (ELISA) showed that the two purified monoclonal antibodies, B7 and B11, recognised the same epitope on the haemolysin molecule. Antibody B7 neutralised the haemolytic and enterotoxic activities of the haemolysin. It is concluded that the same site on the haemolysin molecule is responsible for both haemolytic and enterotoxic activities.

Hypersensitivity angiitis with granulomatous glomerulitis in a patient with preexisting IgA nephropathy.

Following a 6-year history of asymptomatic proteinuria and microhematuria, a 51-year-old man suffered from acute systemic eruption, liver dysfunction and acute renal failure immediately after developing a cold and taking drugs including piroxicam, aspirin and bristocycline. Renal biopsy revealed progressive IgA nephropathy associated with acute tubulointerstitial nephritis and granulomatous glomerulitis. Although the drug actually responsible for this condition was not defined, it is likely that drug-induced hypersensitivity angiitis with granulomatous glomerulitis was superimposed on preexisting IgA nephropathy in this patient.