Masking properties of ceramics for veneer restorations.

STATEMENT OF PROBLEM: The translucency and opacity of ceramics play a significant role in emulating the natural color of teeth, but studies of the masking properties and limitations of dental ceramics when used as monolayer restorations are lacking. PURPOSE: The purpose of this in vitro study was to determine the translucency of 6 materials used for veneer restorations by assessing their translucency parameters (TPs), contrast ratios (CRs), and potential to mask dark tooth colors. MATERIAL AND METHODS: Ten square- or disk-shaped specimens (0.5-mm thickness, shade A2) were fabricated from Vitablocks Mark II (VMII; Vita Zahnfabrik), IPS e.max CAD LT (EMXC LT; Ivoclar Vivadent AG), IPS e.max CAD HT (EMXC HT; Ivoclar Vivadent AG), IPS Empress CAD LT (EMP LT; Ivoclar Vivadent AG), IPS e.max Press LT (EMXP LT; Ivoclar Vivadent AG), and CZR (CZR; Kuraray Noritake Dental Inc). Their luminance (Y) values over black and over white tiles were measured, followed by their color (CIELab) over black tiles and white tiles and shaded A2 (control group), A3.5, A4, and B4 acrylic resin blocks. All measurements were performed using a spectrophotometer in 2 different areas on each specimen. Then CRs, TPs, and color differences (over shaded backgrounds) were determined. Data were subjected to 1-way and 2-way ANOVA (α=.05) for analysis. RESULTS: Mean CR values of EMXP LT were significantly higher than those of the other tested materials, whereas VMII and EMXC HT had the lowest values (P<.001). Mean TP values over black and over white backgrounds of VMII and EMXC HT were significantly higher than those of the other tested materials, while EMXP LT and EMXC LT revealed the lowest values (P<.001). Background shade A4 displayed the highest mean effect (expressed in ΔE* values) on the color of the ceramic materials, whereas shade B4 demonstrated the lowest mean background effect (P<.001). CONCLUSIONS: Significant differences in translucency among the tested ceramics were revealed (P<.001). The EMXC LT and EMXP LT groups were the least translucent under the conditions of this study (P<.001). All tested ceramics exhibited poor masking properties against the A4 background. The color differences of most tested ceramics were more acceptable when tested against the B4 background (ΔE*≤3.3).

Effects of Valsalva Maneuver by Different Breath-holding Techniques to Detect Pulmonary Thromboembolism in a Contrast-enhanced Computed Tomography Examination.

The purpose of this study is to measure the hemodynamics on the effect of Valsalva maneuver aiming at pulmonary thromboembolism (PTE) using 2-dimensional (2D) phase contrast imaging of magnetic resonance image (MRI), Philips Ingenia 3.0-tesla (T). The maximal inspiration reduced the blood flow rate in various degrees at all measurement positions, superior vena cava (SVC), inferior vena cava (IVC), pulmonary artery (PA), ascending aorta (AA), and descending aorta (DA). This result suggests that the contrast effect in the PA might become weak during general PA phase to give a substantial influence of Valsalva maneuver in the condition after maximum inspiration. A contrast-enhanced computed tomography (CT) examination aiming at detection for PTE should be scanned without an advance maximum inspiration.

Archaeal community structures in the solfataric acidic hot springs with different temperatures and elemental compositions.

Archaeal 16S rRNA gene compositions and environmental factors of four distinct solfataric acidic hot springs in Kirishima, Japan were compared. The four ponds were selected by differences of temperature and total dissolved elemental concentration as follows: (1) Pond-A: 93°C and 1679 mg L(-1), (2) Pond-B: 66°C and 2248 mg L(-1), (3) Pond-C: 88°C and 198 mg L(-1), and (4) Pond-D: 67°C and 340 mg L(-1). In total, 431 clones of 16S rRNA gene were classified into 26 phylotypes. In Pond-B, the archaeal diversity was the highest among the four, and the members of the order Sulfolobales were dominant. The Pond-D also showed relatively high diversity, and the most frequent group was uncultured thermoacidic spring clone group. In contrast to Pond-B and Pond-D, much less diverse archaeal clones were detected in Pond-A and Pond-C showing higher temperatures. However, dominant groups in these ponds were also different from each other. The members of the order Sulfolobales shared 89% of total clones in Pond-A, and the uncultured crenarchaeal groups shared 99% of total Pond-C clones. Therefore, species compositions and biodiversity were clearly different among the ponds showing different temperatures and dissolved elemental concentrations.

Laparoscopic cholecystectomy in patients with a previous history of gastrectomy.

BACKGROUND/AIMS: Laparoscopic cholecystectomy (LC) in patients with a previous history of upper abdominal surgery is a difficult procedure with a high conversion rate. METHODOLOGY: Forty-two patients with a previous history of gastrectomy (gastrectomy group) were compared to patients without previous abdominal surgery (no surgery group, n=1375). Patients in the gastrectomy group were divided into two groups for comparison: first, an umbilicus-group (n=12, at the umbilicus) and a side-group (n=23, right of the umbilicus) by the location of the primary port insertion, second, a benign group (n=31) and a malignant group (n=11). RESULTS: Patients in the gastrectomy group had similar operative morbidity but a significantly higher conversion rate and a longer postoperative hospital stay than patients in the no-surgery group. Conversion was performed in four patients in the gastrectomy group (9.5%): 3 in the umbilicus-group and one in a side-group. Two patients in the umbilicus-group had adhesion only just around the primary port site. Patients in the malignant group had similar postoperative hospital stay and morbidity but a significantly longer operating time than patients in the benign group. CONCLUSIONS: Previous gastrectomy for benign or malignant diseases is no longer considered a relative contraindication for performance of safe LC.

Angioscopic study of silent plaque disruption in nonischemic related coronary artery in patients with stable ischemic heart disease.

Plaque disruption, which may be associated with some coronary risk factors, plays a key role in the development of acute coronary syndromes and progression of atherosclerosis. However, the clinical profile of asymptomatic plaque disruption in stable ischemic heart disease has not been well evaluated. The aim of the present study was to investigate the frequency and determinants of silent plaque disruption (SPD) in patients with stable ischemic heart disease using coronary angioscopy. Forty-one patients with stable angina or old myocardial infarction (OMI) without any complaints within 3 months were included in the present study. Angioscopy was successfully performed through 49 nonischemic related coronary arteries. The presence of SPD and coronary risk factors were recorded. Silent plaque disruption was found in 12 patients with stable ischemic heart disease (12/41, 29.3%), and the frequency of SPD in nonischemic related coronary arteries was 26.5% (13/49). A significantly higher frequency of SPD was noted in yellow plaques than in white plaques (35.3% versus 6.7%, P = 0.043). Overall, the independent clinical risk factors of SPD in nonischemic related coronary arteries were diabetes mellitus (P = 0.018; OR, 18.8209; 95% CI, 1.6525 to 214.3523) and hypertension (P = 0.0313; OR, 6.6485; 95% CI, 1.1850 to 37.3019). These results suggest silent plaque disruption was commonly observed in nonischemic related coronary arteries in patients with stable ischemic heart disease and its determinants were diabetes mellitus and hypertension.

Raman spectroscopic study, DFT calculations and MD simulations on the conformational isomerism of N-alkyl-N-methylpyrrolidinium bis-(trifluoromethanesulfonyl) amide ionic liquids.

The conformational behaviors of N-alkyl-N-methylpyrrolidinium bis-(trifluoromethanesulfonyl) amide ionic liquids (alkyl; propyl and butyl, [P(1n)][TFSA]; n = 3 and 4) were studied by Raman spectroscopy in the frequency range of 200-1700 cm(-1) at different temperatures. Observed Raman spectra in the frequency range 870-960 cm(-1) for [P(13)][TFSA] and at 860-950 cm(-1) for [P(14)][TFSA] depend on the temperature, indicating that pseudo rotational isomerization of the pyrrolidinium ring exists in the ionic liquids. DFT calculations revealed that the pseudo rotational potential energy surfaces for P(13)(+) and P(14)(+) ions were similar to each other, i.e., the e6 isomer is the global minimum, whereas the three other isomers e1, e4, and e5 are ca. 3 kJ mol(-1) higher in energy. Optimized geometries with no imaginary frequency were successfully obtained for the e6, e1, and e4 isomers. For both cations, the theoretical Raman spectra of the e6 isomers reproduce well the observed data. To explain their observed Raman spectra in a reasonable way, it is necessary to consider one or more species as predicted by DFT calculations, i.e., the e4 isomer of P(13)(+) rather than the e1, or the e1 isomer of P(14)(+) rather than the e4. In addition, the torsion energy potentials of the alkyl chains of the cations were scanned by DFT calculations. It turns out that the alkyl chains of the cations prefer all trans conformations. It should be emphasized that the alkyl chains of the pyrrolidinium cations show remarkably different conformational behaviors comparing with those of the imidazolium. The isomerization enthalpies Delta(iso)H degrees from the e6 to the e4 isomer of P(13)(+) and to e1 of P(14)(+) were reasonably estimated from the temperature dependence of Raman spectra based on our proposed assignments to be 2.9 kJ mol(-1) for P(13)(+) and 4.2 kJ mol(-1) for P(14)(+), respectively. Thus evaluated experimental Delta(iso)H degrees values, which may contain some uncertainties, are in agreement with those predicted by DFT calculations and MD simulations suggesting that pseudo rotational isomerization equilibria are established in the examined N-alkyl-N-methylpyrrolidinium ionic liquids. The conformational behavior of TFSA(-) was also investigated. The Delta(iso)H degrees from the trans (trifluoromethyl groups on opposite sides of the S-N-S plane) to the cis isomer were evaluated to be 4.2 kJ mol(-1) for [P(13)][TFSA] and 3.5 kJ mol(-1) for [P(14)][TFSA], respectively, which are similar to that for the 1-ethyl-3methylimidazolium ionic liquid.

[Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

Verification of image quality and quantification in whole-body positron emission tomography with continuous bed motion.

OBJECTIVE: Whole-body dynamic imaging using positron emission tomography (PET) facilitates the quantification of tracer kinetics. It is potentially valuable for the differential diagnosis of tumors and for the evaluation of therapeutic efficacy. In whole-body dynamic PET with continuous bed motion (CBM) (WBDCBM-PET), the pass number and bed velocity are key considerations. In the present study, we aimed to investigate the effect of a combination of pass number and bed velocity on the quantitative accuracy and quality of WBDCBM-PET images. METHODS: In this study, WBDCBM-PET imaging was performed at a body phantom using seven bed velocity settings in combination with pass numbers. The resulting image quality was evaluated. For comparing different acquisition settings, the dynamic index (DI) was obtained using the following formula: [P/S], where P represents the pass number, and S represents the bed velocity (mm/s). The following physical parameters were evaluated: noise equivalent count at phantom (NECphantom), percent background variability (N10 mm), percent contrast of the 10 mm hot sphere (QH, 10 mm), the QH, 10 mm/N10 mm ratio, and the maximum standardized uptake value (SUVmax). Furthermore, visual evaluation was performed. RESULTS: The NECphantom was equivalent for the same DI settings regardless of the bed velocity. The N10 mm exhibited an inverse correlation (r < - 0.89) with the DI. QH,10 mm was not affected by DI, and a correlation between QH,10 mm/N10 mm ratio and DI was found at all the velocities (r > 0.93). The SUVmax of the spheres was not influenced by the DI. The coefficient of variations caused by bed velocity decreased in larger spheres. There was no significant difference between the bed velocities on visual evaluation. CONCLUSION: The quantitative accuracy and image quality achieved with WBDCBM-PET was comparable to that achieved with non-dynamic CBM, regardless of the pass number and bed velocity used during imaging for a given acquisition time.

Hypoxia-regulated components of the U4/U6.U5 tri-small nuclear riboprotein complex: possible role in autosomal dominant retinitis pigmentosa.

PURPOSE: High oxygen consumption and cyclical changes related to dark-adaptation are characteristic of the outer retina. Oxygenation changes may contribute to the selective vulnerability of the retina in retinitis pigmentosa (RP) patients, especially for those forms involving genes with global cellular functions. Genes coding for components of the U4/U6.U5 tri small nuclear ribonucleoprotein (tri-snRNP) complex of the spliceosome stand out, because mutations in four genes cause RP, i.e., RP9 (PAP1), RP11 (PRPF31), RP13 (PRPF8), and RP18 (PRPF3), while there is no degeneration outside the retina despite global expression of these genes. With the assumption that variable oxygenation plays a role in RP forms related to pre-mRNA splicing and the retina and brain are similar, we searched a data collection of ischemia-hypoxia regulated genes of the brain for oxygen regulated genes of the U4/U6.U5 tri-snRNP complex. METHODS: A database of ischemia-hypoxia response (IHR) genes in the brain was generated from gene expression profiling studies [n=24]. Public databases (NCBI) were searched for RP genes with global function that are expressed in the brain. From the IHR gene list, we extracted genes that were directly related to retinal degeneration through a listed mutation (OMIM, Retnet, RISN). The database was then examined for indirect links to RP forms affecting the U4/U6.U5 tri-snRNP complex by searching for IHR genes contributing to this complex. Potential expression of matched genes in the retina was ascertained using NEIBank. Immunohistochemistry was used to localize a selected protein of the U4/U6.U5 tri-snRNP complex in cynomolgus monkey and human retina specimens. RESULTS: The approach identified genes that cause retinal degeneration (CNGB1, SEMA4A, RRG4) or developmental changes (SOX2) when mutated. One IHR gene, Pim1, is the immediate binding partner for PAP1 (RP9). Three IHR genes linked the U4/U6.U5 tri-snRNP complex to regulation by oxygenation: PRPF4; SART1, also known as 110 kDa SR-related protein of the U4/U6.U5 tri-snRNP or as hypoxia associated factor (HAF); and LSM8, U6 snRNA-associated Sm-like protein. The 110 kDa SR-related protein was localized in all retinal cells including photoreceptors. CONCLUSIONS: Regulation by changes in oxygenation within the U4/U6.U5 tri-snRP complex could be particularly important for photoreceptors where oxygen consumption follows a circadian rhythm. If the U4/U6.U5 tri-snRP complex is already impaired by mutations in any of the four genes causing RP, it may be unable to follow properly the physiological demands of oxygenation which are mediated by the four hypoxia-regulated proteins emerging in this study. Selective vulnerability may involve complex combinations of widely expressed genes, specific cellular functions and local energy availability.

Six-month aerobic exercise training ameliorates central sleep apnea in patients with chronic heart failure.

BACKGROUND: Sleep-disordered breathing (SDB) is common in patients with heart failure and carries an independent risk for poor long-term prognosis. We aimed to study the effects of supervised, aerobic exercise training for 6 months on SDB in patients with chronic heart failure. METHODS AND RESULTS: We enrolled 18 patients having both systolic dysfunction (left ventricular ejection fraction <45%) and SDB (apnea-hypopnea index [AHI] >10). The exercise group comprised 10 patients who participated in our cardiac rehabilitation program for 6 months, and the remaining 8 patients served as control. AHI (median [interquartile range]) was unchanged in the control group patients at 6-month intervals (30.4 [19.9-36.3] versus 36.6 [8.6-39.4], NS). In contrast, AHI was significantly decreased in the exercise group from 24.9 [19.2-37.1] to 8.8 [5.3-10.1] (P < .01). In the exercise group, the numbers of central sleep apnea per night was significantly decreased (152 [124-244] versus 50 [24-67], P < .01) after exercise training, but those of obstructive apnea/hypopnea were unchanged (42 [7-94] versus 18 [7-54], NS). In addition, exercise training significantly increased peak oxygen consumption and decreased minute ventilation to carbon dioxide production slope (both P < .01). CONCLUSIONS: Six-month, aerobic exercise training increased exercise capacity and improved central sleep apnea in patients with chronic heart failure from systolic dysfunction.

Estimation of intraocular pressure in rabbits with commonly used tonometers.

BACKGROUND AND OBJECTIVES: To validate accuracy and reproducibility of the Perkins tonometer, pneumatonometer, and Tono-Pen XL (Medtronic Solan, Jacksonville, FL) in estimating intraocular pressure (IOP) in rabbits. MATERIALS AND METHODS: IOP was increased from 5 to 50 mm Hg in 5-mm increments. Measurements were compared to readings of two digital manometers simultaneously measuring real IOP in the anterior chamber and vitreous cavity. Interobserver accuracy was evaluated using 4 eyes with the Perkins tonometer. RESULTS: The Perkins tonometer and Tono-Pen XL underestimated IOP and were more accurate at pressures less than 30 mm Hg. No statistically significant difference was found between real IOP and Tono-Pen XL readings. The pneumatonometer overestimated pressures in the low ranges but was accurate at pressures greater than 40 mm Hg. The Tono-Pen XL had more variability than the Perkins tonometer and pneumatonometer at high IOP. CONCLUSIONS: None of the tonometers are accurate or reproducible in estimating IOP in rabbits over the tested range. Pneumatonometry, although not very accurate, has the advantage of having acceptable variability.

[Assessment of the utility of digital subtraction in lacrimal passage contrasting].

The utility of lacrimal passage contrasting by a digital subtraction system (DS system) was assessed in comparison with a computed radiography system (CR system) by means of simulating the exposure dose of a patient's crystalline lens and measuring the image contrast of both systems. The exposure dose of the patient's crystalline lens in the DS system was an average of 45.8 mGy, which was 41.6 times higher than that of the CR system. Therefore, care must be taken to reduce the exposure dose of the crystalline lens because it is necessary to reduce the probability of radiation injuries such as cataracts. The average of the image contrast of the DS system at the lacrimal passage to other parts of the head radiograph was lower than that of the CR system, but the standard deviation of the DS system was 0.16, a value that was almost constant because the shadow of obstacles such as the facial bone was almost completely removed, and image contrast was improved. The area under the curve (AUC) of the DS and CR systems as determined by means of receiver operating characteristic (ROC) analysis by ten radiological technologists were 0.869+/-0.066 and 0.746+/-0.125, respectively, and statistical significance was shown for both systems, although the detectability of the DS system was superior to that of the CR system (p<0.05). Therefore, we concluded that the DS system was a useful radiographic technique for lacrimal passage contrasting, and its use in patients is predicted to increase in the future.

The Effects of the Habitual Consumption of Miso Soup on the Blood Pressure and Heart Rate of Japanese Adults: A Cross-sectional Study of a Health Examination.

Objective It is recommended that middle-aged and elderly individuals reduce their salt intake because of the high prevalence of hypertension. The consumption of miso soup is associated with salt intake, and the reduced consumption of miso soup has been recommended. Recent studies have demonstrated that the consumption of miso soup can attenuate an autonomic imbalance in animal models. However, it is unclear whether these results are applicable to humans. This study examined the cross-sectional association between the frequency of miso soup consumption and the blood pressure and heart rate of human subjects. Methods A total of 527 subjects of 50 to 81 years of age who participated in our hospital health examination were enrolled in the present study and divided into four groups based on the frequency of their miso soup consumption ([bowl(s) of miso soup/week] Group 1, <1; Group2, <4; Group3, <7; Group4, ≥7). The blood pressure levels and heart rates of the subjects in each group were compared. Furthermore, a multivariable analysis was performed to determine whether miso soup consumption was an independent factor affecting the incidence of hypertension or the heart rate. Results The frequency of miso soup consumption was not associated with blood pressure. The heart rate was, however, lower in the participants who reported a high frequency of miso soup consumption. A multivariable analysis revealed that the participants who reported a high frequency of miso soup consumption were more likely to have a lower heart rate, but that the consumption of miso soup was not associated with the incidence of hypertension. Conclusion These results indicate that miso soup consumption might decrease the heart rate, but not have a significant effect on the blood pressure of in middle-aged and elderly Japanese individuals.

Age-related effects and gender differences in Japanese healthy controls for [123I] FP-CIT SPECT.

OBJECTIVE: Dopamine transporter (DAT) imaging with [123I]FP-CIT (DaTSCAN) is a widely used diagnostic tool for Parkinsonism and dementia. Since it was approved by the Japanese Ministry of Health, Labor, and Welfare in 2013, there have been no articles focusing on a Japanese normal population. The aim of this study was to examine the effect of aging and gender on DAT availability in Japanese people. METHODS: SPECT imaging of 30 healthy Japanese controls (17 males, 13 females; range 50-86 years, mean 70 years) was performed. SPECT images were reconstructed using a three-dimensional order subset expectation maximization (OSEM) algorithm with correction of the point spread function and scatter correction, without attenuation correction. The specific binding ratio (SBR) was calculated by DATview software. Statistical analyses were performed using linear regression analysis, analysis of variance, and multiple comparison analysis. RESULTS: A strong correlation between the SBR and age was observed. The correlation coefficient in males and females were -0.566 and -0.502, respectively. The analysis of variance revealed that aging led to a decline of the SBR, and a significant difference (p = 0.005) was observed among generations. Gender also affected the SBR, and there was a significant difference between males and females (p = 0.036). The SBR in females was higher than in males. Consequently, the multiple comparison revealed a significant difference between 50s and 70s (p = 0.015) and 50s and 80s (p = 0.006). CONCLUSIONS: This is the first [123I]FP-CIT SPECT study on subjects with normal dopamine function in Asian countries. This study provides a database of [123I]FP-CIT SPECT in Japanese healthy controls. Higher DAT availability was found in women than in men. An average age-related decline in DAT availability of 8.9% was found in both genders. The data collected in this study would be helpful for Japanese physicians to make a differential diagnosis in Parkinsonian syndrome. The registration identification number for this study is UMIN000018045.

Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease.

OBJECTIVES: The present study evaluated clinical benefits of radiofrequency catheter ablation (RFA) for premature ventricular complexes from right ventricular outflow tract (RVOT-PVC) in patients without structural heart disease. BACKGROUND: It is unknown whether PVC causes left ventricular (LV) dilation, which is a well-recognized precursor of LV dysfunction and heart failure, and whether eliminating PVC by RFA produces clinical benefits in patients with RVOT-PVC. METHODS: Frequency of PVC per total heart beats by 24-h Holter monitoring, left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal dimension (LVDd), mitral regurgitation (MR) by echocardiogram, cardiothoracic ratio (CTR) by chest radiogram, and New York Heart Association (NYHA) functional class of 40 patients with RVOT-PVC without structural heart disease were evaluated before and 6 to 12 months after RFA. RESULTS: Before RFA, a subgroup of patients with frequent (>20%) PVC demonstrated significantly enlarged LVDd and CTR, reduced LVEF, increased MR, and deteriorated NYHA functional class as compared to the subgroup with rare (<20%) PVC (54 +/- 1 mm vs. 45 +/- 1 mm, 52 +/- 2% vs. 46 +/- 1%, 66 +/- 2% vs. 73 +/- 2%, 1.2 +/- 0.2 degree vs. 0.4 +/- 0.1 degree, and 1.8 +/- 0.2 vs. 1.3 +/- 0.1, respectively; p < 0.05). Furthermore, ablating RVOT-PVC readily produced the improvement of all these abnormalities (47 +/- 1 mm, 41 +/- 1%, 72 +/- 2%, 0.3 +/- 0.1 degree, and 1.0 +/- 0.0, respectively; p < 0.05 compared with before RFA). CONCLUSIONS: These findings suggest that frequent (>20%) RVOT-PVC may be a possible cause of LV dysfunction and/or heart failure, and RFA produces clinical benefits in these patients.

A newly designed glaucoma drainage implant made of poly(styrene-b-isobutylene-b-styrene): biocompatibility and function in normal rabbit eyes.

OBJECTIVE: To report clinical evaluation, flow patency, and histopathological findings of a novel glaucoma drainage implant (GDI) made of poly(styrene-b-isobutylene-b-styrene) (SIBS) in rabbits. METHODS: In 16 normal eyes, the proximal end of the SIBS GDI was inserted into the anterior chamber while the distal end was placed in the subconjunctival space. A control group underwent implantation of a similarly designed silicone GDI. Slitlamp follow-up and intraocular pressure measurements were recorded. Flow patency was evaluated by injecting 0.01% fluorescein into the anterior chamber. Immunostaining against collagen IV, macrophages, and alpha smooth muscle actin was performed. RESULTS: Slitlamp examination suggested adequate biocompatibility. A low and diffuse bleb was observed in the SIBS group. All SIBS tubes were patent 6 months after insertion. Immunostaining demonstrated noncontinuous collagen deposition. No macrophages or myofibroblasts were visible around the SIBS tubes. In contrast, silicone induced collagen deposition and myofibroblast differentiation. CONCLUSION: This new GDI is clinically biocompatible in the rabbit and maintained 100% patency at 6 months. A remarkable difference was the absence of myofibroblasts in the surrounding tissue in the SIBS group. CLINICAL RELEVANCE: This novel GDI made of SIBS would prevent the feared complication of hypotony and will decrease the amount of subconjunctival fibrosis.

Treatment of a giant inguinal hernia using transabdominal pre-peritoneal repair.

We present the case of a male Japanese patient with a giant inguinal hernia that extended to his knees while standing. A transabdominal pre-peritoneal (TAPP) repair was performed under general anesthesia. Complete reduction of the contents of the hernia was achieved within 2 h 50 min. A blood loss of approximately 700 ml was noted. The patient was discharged from the hospital on post-operative Day 12, with no recurrence of the hernia 6 months post-surgery. Factors contributing to the successful outcomes included preparation of several reduction methods before surgery, use of a large size mesh and implementation of pre-operative measures to prevent abdominal compartment syndrome. Further studies are required to evaluate the feasibility of laparoscopic repair in the management of giant inguinal hernia.

Surgical treatment for colorectal liver metastases involving the paracaval portion of the caudate lobe.

BACKGROUND: Hepatic neoplasms in the paracaval portion of the caudate lobe (S1r) are usually difficult to treat surgically because such neoplasms often invade the hepatic veins and/or inferior vena cava (IVC). We reevaluated resected cases of colorectal liver metastases involving S1r to confirm the significance of aggressive surgical treatments. METHODS: Between July 1977 and December 2002, 95 consecutive patients with colorectal liver metastases underwent hepatic resection. Seven patients with liver metastases involving the S1r underwent resection. RESULTS: The surgical procedures for liver metastases comprised 3 isolated caudate lobectomies, 2 right hepatectomies, and 2 right hepatic trisectionectomies with caudate lobectomy. Combined resections included partial resection of the hepatic vein in 2 patients, wedge resection of the IVC in 3, and segmental resection of the IVC in 1. Six of the 7 patients with S1r metastasis had recurrent disease in liver and/or lung. A second hepatectomy was carried out in 4 patients and a partial lung resection in 2 patients. Four of the 7 patients survived more than 5 years, but 2 of them died of recurrent disease at 61 and 95 months after initial hepatectomy. The remaining 2 patients are alive 72 and 118 months without any sign of recurrence. The median survival time of the 7 patients was 60 months. CONCLUSION: Liver metastases involving the S1r could be resected radically with en bloc resection of the major hepatic veins and/or the inferior vena cava. An aggressive surgical approach with combined resection of the adjacent major vessels may offer a better chance of long-term survival in selected patients with caudate lobe metastasis from colorectal cancer.