One-stop shop for 3-dimensional anatomy of hepatic vasculature and bile duct with special reference to biliary image reconstruction.

BACKGROUND/AIMS: Three-dimensional CT has become an essential tool for successful hepatic surgery. Up to now, efforts have been made to simultaneously visualize hepatic vasculature and bile ducts. Herein, we introduce a new one-stop shop approach to hepatic 3D-anatomy, using a standard enhanced MDCT alone. METHODOLOGY: A 3D-reconstruction of hepatic vasculature was made using data from contrast enhanced MDCT and SYNAPSE VINCENT software. We identified bile ducts from axial 2D image, and then reconstructed the 3D image. Both hepatic vasculature and bile duct images were integrated into a single image and it was compared with the 3D image, utilized with MRCP or DIC-CT. RESULTS: The first branches of both the right and left hepatic ducts were hand-traced and visualized for all 100 cases. The second branches of these ducts were visualized in 69 cases, and only the right second branch was recognized in 52 cases. Anomalous variations of bile ducts, such as posterior branch joining into common hepatic duct, were recognized in 12 cases. These biliary tract variations were all confirmed by MRCP or DIC-CT. CONCLUSIONS: Our new one-stop shop approach using the 3D imaging technique might contribute to successful hepatectomy as well as reduce medical costs and radiation exposure by omission of MRCP and DIC-CT.

Loss of Secreted Frizzled-Related Protein-1 expression is associated with poor prognosis in intrahepatic cholangiocarcinoma.

AIMS: Secreted Frizzled-Related Protein-1 (SFRP1) is a well-known negative regulator of the wingless type (Wnt)-ß-catenin pathway and its inactivation plays an important role in the development and progression of many cancers. In this study, we aimed to determine the clinical significance of SFRP1 expression in intrahepatic cholangiocarcinoma (IHCC) and to define the relationship to Wnt-ß-catenin pathway. METHODS: Fifty IHCC patients who had liver resection were enrolled in this study. SFRP1 protein expression was examined by immunohistochemistry in tumor tissues. The patients were divided into two groups: SFRP1 positive (n = 30) and negative (n = 20). Clinicopathological characteristics were analyzed. RESULTS: SFRP1 significantly correlated with curability (Cur A, B vs. C, p = 0.029); and recurrent pattern (intrahepatic vs. extrahepatic, p = 0.010). The negative SFRP1 group had significantly poorer prognosis, and 5-year survival rates were 8.1% of the negative SFRP1 group and 44.6% of the positive SFRP1 group, respectively. Moreover, the disease-free survival rate in the negative SFRP1 group was significantly poorer (p < 0.001). Multivariate analysis revealed that loss of SFRP1served as an independent prognostic factor in IHCC for both overall (HR, 2.923; 95% CI, 1.30-6.56; p = 0.009) and disease-free (HR, 2.631; 95% CI, 1.31-5.27; p = 0.006) survival. In addition, SFRP1 expression negatively correlated to ß-catenin expression (p = 0.005). CONCLUSIONS: Those results suggested that the loss of SFRP1 could be a poor prognostic factor for IHCC, through the Wnt-ß-catenin pathway.

Abundance and diversity of functional genes involved in the degradation of aromatic hydrocarbons in Antarctic soils and sediments around Syowa Station.

Hydrocarbon catabolic genes were investigated in soils and sediments in nine different locations around Syowa Station, Antarctica, using conventional PCR, real-time PCR, cloning, and sequencing analysis. Polycyclic aromatic hydrocarbon ring-hydroxylating dioxygenase (PAH-RHD)-coding genes from both Gram-positive and Gram-negative bacteria were observed. Clone libraries of Gram-positive RHD genes were related to (i) nidA3 of Mycobacterium sp. py146, (ii) pdoA of Terrabacter sp. HH4, (iii) nidA of Diaphorobacter sp. KOTLB, and (iv) pdoA2 of Mycobacterium sp. CH-2, with 95-99% similarity. Clone libraries of Gram-negative RHD genes were related to the following: (i) naphthalene dioxygenase of Burkholderia glathei, (ii) phnAc of Burkholderia sartisoli, and (iii) RHD alpha subunit of uncultured bacterium, with 41-46% similarity. Interestingly, the diversity of the Gram-positive RHD genes found around this area was higher than those of the Gram-negative RHD genes. Real-time PCR showed different abundance of dioxygenase genes between locations. Moreover, the PCR-denaturing gradient gel electrophoresis (DGGE) profile demonstrated diverse bacterial populations, according to their location. Forty dominant fragments in the DGGE profiles were excised and sequenced. All of the sequences belonged to ten bacterial phyla: Proteobacteria, Actinobacteria, Verrucomicrobia, Bacteroidetes, Firmicutes, Chloroflexi, Gemmatimonadetes, Cyanobacteria, Chlorobium, and Acidobacteria. In addition, the bacterial genus Sphingomonas, which has been suggested to be one of the major PAH degraders in the environment, was observed in some locations. The results demonstrated that indigenous bacteria have the potential ability to degrade PAHs and provided information to support the conclusion that bioremediation processes can occur in the Antarctic soils and sediments studied here.

Inner architecture of human and simian immunodeficiency viruses.

The cores of human and simian immunodeficiency viruses (HIV and SIV) were observed by negative staining after isolation of the core with Nonidet P40 and glutaraldehyde. Four kinds of cores were found: asymmetric and symmetric sectoral shapes, a bar shape, and a triangular shape. These results were confirmed by the examination of ultrathin sections of whole virions. In some virions, the connection between the core and the envelope was observed after freeze fracturing. Its structure was considered to be characteristic of an intermediate stage of viral maturation. The HIV-1 core was reacted with anti-HIV-1 p24 mouse monoclonal antibody.

Quantitative analysis of the spinal cord motoneuron under chronic compression: an experimental observation in the mouse.

We investigated quantitative changes in spinal cord motoneurons following chronic compression using a mouse model of cervical cord compression. Twenty-five tip-toe-walking Yoshimura (twy) mice with calcified mass lesions compressing the spinal cord posterolaterally at the C1-C2 vertebral levels were compared with five Institute of Cancer Research (ICR) mice that served as controls. Spinal cord motoneurons in the anterior grey horn between the C1 and C3 spinal cord segments were Nissl-stained and counted topographically and then analysed in relation to the extent of spinal cord compression. The number of motoneurons in C1-C3 spinal cord segments decreased significantly with a linear correlation with the transverse area of the spinal cord when the cord was compressed to 50-70% of control values. A significant reduction in the number of motoneurons occurred at the C2-C3 spinal cord segment compressed at the C1-C2 vertebral level. In contrast, at the level rostral to the C1 vertebra, the number of motoneurons increased significantly in proportion to the magnitude of compression. The current study demonstrates that a number of neurons, morphologically consistent with anterior horn cells, were observed at a rostral site absolutely free of external compression where no such cells normally exist.

Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study.

We investigated lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy. Fifty-five patients (32 men and 23 women) were studied, with an average follow-up of 2.4 years. Radiological examination included evaluation of lordosis of the cervical spine and spinal cord, degree of enlargement of bony spinal canal, and the magnitude of posterior cord migration. We also correlated these changes with neurological improvement. Postoperatively, there was an average of 5% loss of cervical spine lordosis (P > 0.01) on radiographs and 12% reduction in the lordotic alignment of the spinal cord (P > 0.05) on magnetic resonance imaging. Postoperatively, the size of the bony spinal canal increased by 48%. Posterior cord migration showed a significant correlation with the preoperative cervical spine and spinal cord lordosis (P < 0.05). Thirty-seven (67%) patients with neurological improvement exceeding 50% showed significant posterior cord migration following laminoplasty compared with those demonstrating less than 50% improvement (P = 0.01). Our results suggest that a significant neurological improvement is associated with posterior cord migration after cervical laminoplasty.

Plasticity of the spinal cord contributes to neurological improvement after treatment by cervical decompression. A magnetic resonance imaging study.

To investigate the relationship between morphological plasticity of the spinal cord and neurological outcome after surgery for compressive lesions, we correlated the transverse area of the cervical spinal cord measured by transaxial magnetic resonance imaging (MRI) obtained during the early postoperative period (1-6 months) with neurological function assessed at a median postoperative follow-up period of 2.5 years. Measurements on MRI in 56 patients (35 men and 21 women) included evaluation of the cross-sectional area of the cervical cord and the subarachnoidal space at the level of decompression. The transverse area of the cervical cord increased by 30 to 62% postoperatively and that of the subarachnoidal space by 57 to 95%. Neurological improvement was noted in all patients and averaged 63% in our assessment scale. Expansion of the cervical cord during the early postoperative period correlated significantly with the late postoperative neurological status (P = 0.009). Our results suggest that an increase in the cross-sectional area of the cervical spinal cord, representing spinal cord morphological plasticity, is a significant factor in determining the late neurological improvement following decompressive surgery.

Histological investigation of spinal cord lesions in the spinal hyperostotic mouse (twy/twy): morphological changes in anterior horn cells and immunoreactivity to neurotropic factors.

We examined the morphology of spinal accessory motoneurons and immunoreactivity to neurotrophins, brain-derived neurotropic factor (BDNF) and neurotrophin (NT)-3, as well as the presence of reactive astrocytosis in 70 tiptoe walking Yoshimura (twy) mice that develop calcification at C1-C2 vertebral level compressing the spinal cord. At the level of compression, the area of neuronal soma and total length of dendrites of wheat germ agglutinin-horseradish peroxidase (WGA-HRP)-labelled accessory motoneurons in the medial cell pool decreased significantly with decrement in motoneuron population, relative to the control. In contrast, at sites rostral to the compressive lesion, a significant enlargement of the neuron soma and dendritic elongation were noted, associated with increased motoneuron population and decreased transverse area of the cord at the level of compression. At this site, enhanced BDNF and NT-3 immunoreactivities were evident in the anterior horn cells. In mice with a more severe degree of compression, astrocyte-like cells showing BDNF immunoreactivity became abundant and axons in the anterior column demonstrated a marked NT-3 immunoreactivity. Our results suggest increased functional activity of anterior horn cells at levels rostra] to the site of compression. We speculate that the presence of BDNF and NT-3 in neurons and astrocyte-like cells is proportionate to the severity of chronic mechanical compression and may contribute to the heterotropic neuronal reserve and survival.

Three-dimensional topographic analysis of spinal accessory motoneurons under chronic mechanical compression: an experimental study in the mouse.

We investigated the effect of chronic mechanical compression of the cervical spinal cord on the number of spinal accessory motoneurons in 25 tiptoe-walking Yoshimura mice. The animals had calcified deposits in the atlantoaxial membrane at the C1-C2 vertebral level, compressing the spinal cord posterolaterally. Motoneurons of the spinal accessory nerve between C1 and C5 segments were labelled using wheat germ agglutinin-horseradish peroxidase (WGA-HRP) injected into the sternocleidomastoid muscles. The counted cells were processed into a three-dimensional computer display to analyse the cytoarchitectonic changes caused by external cord compression. The number of WGA-HRP-labelled spinal accessory motoneurons was significantly reduced on the affected side. The number of motoneurons in compromised C2 and C3 cord segments correlated linearly with the extent of mechanical compression, but no such relationship was present on the contralateral side. There was an increase in the number of WGA-HRP-labelled spinal accessory motoneurons in the medial cell pools of the anterior grey horn at a level most rostral to the compression, and in the ventrolateral cell pools at levels immediately rostral to the compression. Our findings suggest that the spinal accessory motoneurons translocate rostral to the area of external compression in order to avoid mechanical injury.

Relationship between radiographic classification and arthroscopic findings of articular cartilage lesions in osteoarthritis of the knee.

OBJECTIVE: To examine the relationship between radiographic abnormalities and arthroscopic findings of the cartilage lesions in patients with osteoarthritis (OA) of the knee. METHODS: Arthroscopy was performed in 190 patients with primary medial compartment (MC) OA of the knee to assess the severity of the cartilage lesion. Standing radiographs of all patients were graded according to the joint space narrowing (JSN) and Kellgren-Lawrence (K/L) scales. In addition to evaluating the correlation between arthroscopic articular cartilage lesions and the radiographic scale, multiple regression analysis was used to identify the arthroscopic findings and clinical factors that influenced the cartilage lesions. RESULTS: The positive predictive values of the JSN and K/L scales of the MC for the presence of essentially abnormal articular cartilage in the MC by arthroscopy were high (0.98, 0.96, respectively). The sensitivity and specificity of the JSN scale and the sensitivity and negative predictive value of the K/L scale were also high in the MC. In contrast, the positive predictive values of these radiographic scales for the presence of arthroscopic lesions in the lateral compartment (LC) were poor (0.20 and 0.19). In this study population with severe OA, there were more patients with a high K/L score than with a high JSN score in the MC. CONCLUSION: In MC-OA of the knee, the JSN and K/L scores for the MC correlated highly with cartilage lesions of the MC by arthroscopy. However, the cartilage lesion of the LC correlated poorly with both of these radiographic scales.

Calcium crystal deposition in the ligamentum flavum of the lumbar spine.

OBJECTIVE: To investigate the histological and immunohistochemical properties of the lumbar ligamentum flavum with calcium crystal deposition. METHODS: We examined the histological characteristics of the ligamentum flavum of the lumbar spine containing calcium deposits, obtained from 16 surgical cases with symptomatic lumbar spinal stenosis. Sections of the ligaments were also immunostained for elastase, chymotrypsin and S-100 protein, and examined by energy dispensive X-ray microanalysis and scanning electron microscopy. The results were compared with those of ligaments without calcium deposits. RESULTS: The elastic fibres of ligaments with calcium deposits showed marked degeneration (irregular arrangement and fragmentation of the fibre bundles) and nodular granulomatous lesions. Calcium crystal deposits were present in this area and in the nodular granulomatous areas. The calcified areas were surrounded by neutrophils and new small blood vessels. Immunostaining for elastase and chymotrypsin was positive in these areas, and S-100 protein-containing chondrocytes were detected around and within the calcified areas. Calcium pyrophosphate dihydrate crystals were identified in the calcified areas in all patients. CONCLUSION: Nodular degeneration of the elastic fibres of the ligament is probably caused by the action of proteolytic enzymes. Degeneration results in small granulomatous areas that form the nidus for calcium crystal deposition. Accumulated neutrophils, and S-100 protein-containing chondrocytes appear to precipitate the deposition of calcium crystals in the granulomatous lesions of the degenerated lumbar ligamentum flavum.

Peroneal island flap for skin defects in the lower extremity.

Two types of peroneal island-flap transfer were used in fourteen patients with a large defect in the soft tissues of the lower extremity. The peroneal artery and vein and their cutaneous branches form the pedicle, and an extensive transfer of skin is possible either from above the knee or from the lateral side of the leg to as far distal as the foot. Two methods were used: in the first we severed the peroneal artery and vein distally, with an island of skin attached, and elevated them proximally, and in the second we severed the proximal portions of the peroneal vessels, with an island of skin attached, and elevated them distally. The largest flap that we used in this series measured fourteen by 16.5 centimeters and the smallest, 2.5 by five centimeters. All fourteen transfers healed, with no necrosis of the flap.

Steroid-responsive painful ophthalmoplegia in childhood: sphenoid sinusitis presenting as Tolosa-Hunt syndrome.

A childhood case of painful ophthalmoplegia which responded well to steroids was described. Although the clinical features suggested Tolosa-Hunt syndrome (THS), serial magnetic resonance imagings (MRI) revealed ethmoid and sphenoid sinusitis in this 7-year-old boy. It was considered that multiple factors such as allergy, viral infection and swimming predisposed him to develop severe sinusitis and gave rise to his painful ophthalmoplegia.

Magnetic resonance signal intensity ratio of gray/white matter in children. Quantitative assessment in developing brain.

Magnetic resonance imaging (MRI) findings in 87 children with various clinical entities were used to determine the signal intensity ratio of gray/white matter in T1- and T2-weighted images using a 1.5 T MR Scanner. Signal intensity ratio changes in both T1- and T2-weighted images correlated well with advancing age (y = 0.9349-0.001575, r = -0.584, P < 0.0001 in T1-weighted images; y = 0.9798 + 0.002854, r = 0.723, P < 0.0001 in T2-weighted images), but the correlation was more linear when we included only normally developed (34) children (y = 0.9689-0.001967, r = -0.654, P < 0.0001 in T1-weighted images; y = 0.9882 + 0.002965, r = 0.747, P < 0.0001 in T2-weighted images). Abnormal ratios were observed in patients with congenital hydrocephalus, inherited metabolic diseases and cerebral palsy. Although the gray/white matter differentiation would not delineate the myelination itself, measurement of the signal intensity ratio of gray/white matter is a practical way to evaluate delayed myelination in a busy MR center.

A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure.

A multicenter randomised trial was conducted in nine neonatal centers in Japan to re-evaluate the safety and the efficacy of high frequency oscillatory ventilation using the piston type oscillator (Hummingbird) in the treatment of respiratory failure in preterm infants weighing between 750 and 2000 g at birth. A total of 92 infants were enrolled in the study. Forty-six infants were allocated to high frequency oscillatory ventilation and 46 infants to conventional mechanical ventilation. There were no differences in sex, birth weight, gestation and Apgar score between groups. The study was begun 2.0 +/- 1.6 h (mean +/- S.D.) after birth in the high frequency oscillation group and 1.7 +/- 1.5 h after birth in the conventional mechanical ventilation group. The absence of intraventricular hemorrhage was confirmed by echography in all cases before beginning ventilation. Mortality was similar in high frequency oscillatory ventilation and conventional mechanical ventilation (0 and 2%). The incidence of intraventricular hemorrhage was also similar in the high frequency and conventional mechanical ventilation groups (15 and 13% overall; 4 and 2% in grades III and IV, respectively). Nine percent of the infants in high frequency oscillatory ventilation and 13% in conventional mechanical ventilation developed bronchopulmonary dysplasia, but the difference was not significant. The frequency of air leaks was also equal in both groups. Periventricular leukomalacia was detected in 9% of infants on conventional mechanical ventilation and 2% on high frequency oscillation, but the difference was not significant. Mean airway pressure was significantly higher in the high frequency oscillatory ventilation group and the infants on high frequency oscillation showed a significantly higher arterial to alveolar oxygen tension ratio after 6 h of treatment. These results suggest that high frequency oscillatory ventilation does not increase the risk of severe complications such as air leaks, intraventricular hemorrhage or periventricular leukomalacia when it is used by experienced neonatologists. Indeed high frequency oscillatory ventilation helps provide better oxygenation with higher mean airway pressure without increasing the risk of bronchopulmonary dysplasia and severe complications such as air leaks and intraventricular hemorrhage.

Postoperative bone re-growth in lumbar spinal stenosis. A multivariate analysis of 48 patients.

STUDY DESIGN: Forty-eight patients who underwent posterior decompressive surgery for lumbar spinal stenosis were studied. The effect of bone re-growth after posterior decompression in lumbar spinal stenosis on clinical outcome and the factors promoting the bone re-growth were investigated with a multivariate analysis model. METHODS: Bone re-growth at the sites operated upon was evaluated as a percentage of re-growth of the original laminectomy site based upon plain radiographs. The degree of bone re-growth was classified into four groups: 1) no significant re-growth (Group I, bone regrowth rate 10% or less); mild (Group II, 11% to 40%), moderate (Group III, 41% to 70%), and marked (Group IV, 71% to 100%). The average follow-up period was 4.5 years (range, 2 to 7 years). RESULTS: No significant bone re-growth was shown in 6% of the patients. Mild re-growth was shown in 50%, moderate re-growth in 29%, and marked re-growth in 15%. A multivariate analysis indicated that a total block in the preoperative myelogram, a follow-up period of more than 5 years, decompression at more than three spinal levels, and age under 60 years were associated with moderate or marked bone re-growth. Spinal instability accelerated the bone re-growth mainly in the mid and later follow-up intervals. Spinal levels adjacent to a fusion showed more bone re-growth. Patients with moderate and marked bone re-growth had poorer clinical outcomes than those with no significant and mild bone re-growth. CONCLUSION: Bone re-growth in a surgical defect will occur in most patients after posterior decompression. Moderate and marked postoperative bone re-growth are possibly related to recurrence of neurologic symptoms in the middle of and later on in follow-up periods.

Spinal cord evoked potentials in thoracic myelopathy with multisegmental vertebral involvement.

Spinal cord evoked potentials were recorded preoperatively from the thoracic epidural space after spinal cord stimulation in 20 patients with thoracic myelopathy with multisegmental vertebral involvement. Waveform abnormalities in spinal cord evoked potentials, namely, positive-going wave or decrease in amplitude, were observed in all cases. Abnormalities, especially in the first negative component of spinal cord evoked potentials, were recorded at the most compressed site in each case. Decrease in amplitude of more than 50% was noted frequently in moderately involved cases, whereas positive-going wave was elicited predominantly in cases of severe myelopathy. Spinal cord evoked potentials should provide information for determining the range of decompression in multisegmental vertebral involvement.

Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy.

A retrospective study was performed to evaluate the radiographic changes that occurred at spinal levels adjacent to fused vertebrae after anterior cervical fusion. One hundred six patients with cervical spondylotic myeloradiculopathy (88 men, 18 women) were followed for an average of 8.5 years. The average age at follow-up was 64 years. Forty-two patients underwent a single-level fusion, 52 had a two-level fusion, and 12 had three levels fused. Seventeen patients who underwent additional surgery after anterior fusion also were reviewed, with an average follow-up period of 2.9 years. Postoperatively, cervical flexion-extension resulted in significantly increased movement about the vertebral interspace at the upper adjacent level. An increment of posterior slip of the vertebra immediately above the fusion level, with associated spinal canal compromise of less than 12 mm, significantly affected neurologic results. Patients with multilevel fusions notably exhibited these radiographic abnormalities at adjacent levels. Spinal canal stenosis, when associated with dynamic spinal canal stenosis in the vertebra above the fusion level, affected late neurologic results. Results of salvage laminoplasty were not satisfactory. Unnecessarily extended longer fusion must be avoided.

Calcium crystal deposition in the ligamentum flavum of the cervical spine.

This article reports eight patients who underwent posterior decompressive surgery for myeloradiculopathy caused by calcium crystal deposition in the ligamentum flavum of the cervical spine. All were women with an average age of 72 years and showed neurologic improvement postoperatively. Four patients had diabetes mellitus, and knee meniscus calcification on radiographs were noted in four patients. The ligamentum flavum of C5-6 and C6-7 were sites frequently involved. Crystallographic examination confirmed resected deposits as calcium pyrophosphate dihydrate crystal in all patients and additional hydroxyapatite crystal in two. Histology confirmed marked degeneration in elastic fibers about the calcium deposits. This pathologic condition is possibly spinal manifestation of systemic calcium crystal deposition disease.

Laminoplasty with foraminotomy for coexisting cervical myelopathy and unilateral radiculopathy: a preliminary report.

STUDY DESIGN: An assessment was made of the efficacy of a combined laminoplasty and foraminotomy operation for patients with coexisting myelopathy and unilateral radiculopathy. The procedure was done in 17 patients. OBJECTIVES: The patients were followed with lateral flexion and extension radiographs, computed tomography scans, and an assessment system specially designed to qualitatively evaluate the patients' neurologic status. Follow-up period averaged 4 years (range, 2.1-9.3 years). SUMMARY OF BACKGROUND DATA: Excellent-to-good results were obtained for 76% (13 of 17) of the patients without any significant functional compromise based on the radiographs. Sixteen nerve roots were decompressed with a less than 25% foraminotomy, whereas eight were decompressed by a 25%-50% foraminotomy without serious neurologic damage, except for one patient. The neurologic results appeared unrelated to the extent of foraminotomy. METHODS: A refined procedure for combined laminoplasty and foraminotomy was reviewed retrospectively in terms of neurologic outcome and radiographic data. RESULTS: The present series is small, and results are not comparable directly with other methods. The procedure appears effective for myelopathy and radiculopathy. This procedure is applicable to patients with myelopathy and coexisting nerve root impingement anterolaterally or in the neural foramen. CONCLUSION: The combined laminoplasty and foraminotomy operation may provide greater neurologic improvement in patients with coexisting myelopathy and unilateral radiculopathy, while maintaining cervical spine stability after surgery.