Clinical statistics on operations for inpatients at Department of Urology, Tokai University Hospital 1975-1989]

Operations on inpatients during the 15-year period from 1975 to 1989 were analyzed statistically. A total of 3,791 operations were performed at our Department of Urology, including 717 operations on the kidney, 316 operations on the ureter, 583 operations on the bladder, 811 operations on the prostate, 136 operations on the urethra, 1,097 operations on the scrotum, 43 operations on the adrenal gland, 19 operations on the retroperitoneal space and 69 operations on other organs.     

Statistics on operations at the Department of Urology, School of Medicine, Tokai University (January, 1982 to March, 1984)

A total of 794 operations were performed at the Department of Urology, Tokai University Hospital between January, 1982 and March, 1984, including 5 operations on the adrenal gland, 64 operations on the kidney, 48 operations on the ureter, 93 operations on the urinary bladder, 124 operations on the prostate, 25 operations on the urethra, 124 operations on the penis, 190 operations on the scrotum and 19 operations on other organs.     

A controlled, double-blind, cross-over study of terodiline in motor urge incontinence

In a placebo-controlled, randomized, double-blind, cross-over study, terodiline (50 mg/d) was compared with emepronium (600 mg/d) in 20 patients with motor urge incontinence. Evaluation of clinical efficacy was based on changes in micturition pattern, flow measurements, residual urine, cystometry and patient preferences, and safety on adverse reactions, blood chemistry, urine examinations and ECG. The number of voluntary micturitions decreased from a mean of 21.5 per 48 h on placebo by 1.6 on terodiline and 2.8 on emepronium. Involuntary micturitions decreased from 3.6 per 48 h by 1.3 on both treatments (p less than 0.05). The maximal flow rate decreased from a mean of 24.5 ml/sec to 19.6 ml/sec on emepronium and increased to 25.4 ml/sec on terodiline. Residual urine decreased from a mean of 54 ml to 49 ml on terodiline and increased to 60 ml on emepronium. Volume at first desire to void in the supine position increased on emepronium by 44 ml (p less than 0.05) and on terodiline by 3 ml, on the upright position by 11 ml and 18 ml, respectively. Bladder capacity increased in the supine position on emepronium by 32 ml and decreased on terodiline by 8 ml, in the upright position increased by 9 ml and 5 ml, respectively. The bladder pressure at first desire to void in the supine position increased on emepronium by 2 cmH2O, and decreased on terodiline by 2 cmH2O. The intravesical pressure at strong desire to void decreased on emepronium by 6 cmH2O and on terodiline by 7 cmH2O, in the upright position by 2 cmH2O and 1 cmH2O, respectively. 39% of the patients preferred terodiline, 39% emepronium and 22% placebo.(ABSTRACT TRUNCATED AT 250 WORDS)     

Quantitative evaluation of the growth of established cell lines on the surface of collagen,collagen composite and reconstituted basement membrane

Summary As a step in the development of a system for assessing growth of human urothelium and transitional cell carcinoma, the growth of two established cell lines on collagen-based membranes has been evaluated. HT1080 (metastatic human fibrosarcoma) and WI38 VA13 (virus-transformed human fibroblasts) were grown on substrates of collagen, collagen/hyaluronic acid or chondroitin sulphate and reconstituted basement membrane (Matrigel). Cell growth was quantified using a new fluorimetric assay utilizing carboxyfluorescein diacetate. There were differences in morphology between cells grown on collagen and those grown on polystyrene. There were, however, no differences in growth of the WI38 VA13 cells on collagen compared with polystyrene, but growth of the HT1080 cells was increased on membranes of collagen/2:5% hyaluronic acid and collagen/5% chondroitin sulphate, and decreased on Matrigel. Adequate growth on collagen substrates is dependent on cell line. The fluorimetric assay used was suitable for quantifying cell growth on such substrates.     

Dialysis outcomes and analysis of practice patterns suggests the dialysis schedule affects day-of-week mortality

The risk of death for hemodialysis patients is thought to be highest on the days following the longest interval without dialysis (usually Mondays and Tuesdays); however, existing results are inconclusive. To clarify this we analyzed Dialysis Outcomes and Practice Patterns Study (DOPPS) data of 22,163 hemodialysis patients from the United States, Europe, and Japan. Our study focused on the association between dialysis schedule and day of the week of all-cause, cardiovascular, and noncardiovascular mortality with day-of-week coded as a time-dependent covariate. The models were adjusted for dialysis schedule, age, country, DOPPS phase I or II, and other demographic and clinical covariates, and compared mortality on each day to the 7-day average. Patients on a Monday-Wednesday-Friday (MWF) schedule had elevated all-cause mortality on Mondays, and those on a Tuesday-Thursday-Saturday (TTS) schedule had increased risk of mortality on Tuesdays in all three regions. The association between day-of-week mortality and schedule was generally stronger for cardiovascular than noncardiovascular mortality, and was most pronounced in the United States. Unexpectedly, Japanese patients on a MWF schedule had a higher risk of noncardiovascular mortality on Fridays, and European patients on a TTS schedule experienced an elevated cardiovascular mortality on Saturdays. Thus, future studies are needed to evaluate the influence of practice patterns on schedule-specific mortality and factors that could modulate this effect.     

对脊柱侧凸畸形手术矫治中整体观点的探讨

根据脊柱侧凸的三个主要畸形：某段脊柱的弯曲，凸侧剃刀背的隆起，及凹侧的塌陷。作者在哈灵顿手术的基础上，进行了剃刀背部分肋骨节段切除，弯曲脊柱的撑开和凹侧肋骨的提升等手术，对改善外观有明显效果。强调在矫形手术时，必须具有整体的观点。     

Daily practices, consumption and citizenship

This paper promotes a reflection on the relationship between daily practices and consumption. Understanding how conflicts, resistance and consensus are generated from daily consumption practices opens up possibilities for reflecting on the construction of sustainability in the context of diversity, one of the landmarks of the globalized world. Within this socio-cultural context, the central issue is: can consumption generate citizenship practices? The concepts of subject and agent help one think about collective action and subjectivation processes and their interferences on the collective consuming behavior. Based on empirical data from a research carried out in the municipality of Estrela in 2007, in the Taquari Valley - Rio Grande do Sul (Southern Brazil) on local reality consumption practices, it was possible to conclude that various reasoning mechanisms and values underlie the daily consumption practices. Citizenship construction, based on consumption practices, depends on the subject's reflection capacity on his/her daily practices or on what goes through the circulation of environmental information based on sociability spaces.     

MRI对椎体骨折与愈合过程的评价

目的总结与评价MRI对外伤性椎体骨折的诊断和愈合过程的诊断价值。方法回顾性分析62例椎体外伤骨折．共83个椎体．分为压缩性骨折、爆裂性骨折、隐匿性骨折。结果新鲜压缩性骨折T1WI信号，T2WI呈高信号，STIR序列呈高信号：陈旧压缩性骨折T1WI呈高信号，T2WI呈低信号，STIR序列呈低信号；爆裂性骨折T1WI呈高低混杂信号，T2WI呈高信号，STIR序列呈高信号。椎体呈分裂状：隐匿性骨折为T1wI及T2WI对应位置条状低信号，且于T1WI低信号周同见片状高信号，STIR序列呈高信号．结论MRI可以从椎体信号的变化来评价椎体外伤性骨折的程度与康复过程，且能够弥补传统X线与CT诊断椎体骨折的诸多不足之处。     

Surgical statistics of the Department of Urology, Isesaki Municipal Hospital during a five-year period (June 1998-May 2003)

We reviewed the surgical statistics of the Department of Urology, Isesaki Municipal Hospital between June 1998 and May 2003. A total of 1940 surgeries were performed. These consisted of 399 surgeries on the kidney, adrenal, and pelvis, 212 on the ureter, 433 on the bladder, 256 on the prostate, 149 on the urethra and the penis, 192 on the scrotum, 255 on the arteriovenous fistula and CAPD. In September 2003, a screening program for prostate cancer was started, and the number of prostate biopsies and total prostatectomies increased. As the adaptation of many procedures to laparoscopy expanded, the number of laparoscopic surgeries increased.     

Post-tonsillectomy pain: a prospective, randomised and double-blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique

Thirty-two patients participated in a study to compare the use of an ultrasonically activated scalpel (Harmonic scalpel) for tonsillectomy on one side and a blunt dissection tonsillectomy on the other. Pain scores at rest and on swallowing expressed as the area under curves (AUC) during the 10 h after surgery, intra-operative blood loss and the need for electrocoagulation for haemostasis were significantly higher on the blunt dissection side than on the Harmonic scalpel side (p < 0.05). However, pain scores expressed as AUC at rest, on swallowing, the day's least, average and worst levels of pain, and the day's worst otalgia during the second week after surgery were significantly higher on the Harmonic scalpel side than on the blunt dissection side. In conclusion, we found that Harmonic scalpel tonsillectomy was associated with decreased severity in pharyngeal pain on the day of the operation but increased pharyngeal pain and otalgia during the second postoperative week.     

Preliminary Observations on the Effect of Parity on First Day Ultrasonic Detection of Embryo and its Organs in Bovine

The aim of this study was to determine the effect of parity on the first day of ultrasonic detection of embryo and its organs using 8 MHz frequency. For this purpose, six nulliparous heifers, five primiparous cows and six multiparous cows of the Holstein breed were selected and mated by a single bull from the herd. From day 16 after mating, cows and heifers were examined by ultrasonography thrice weekly for the day of first detection of the embryo and its organs. The mean of first‐day detection in heifers, primiparous and multiparous cows was as follows, respectively: allantois on days 22.3, 23 and 25.8; embryo proper on days 21.8, 23 and 27; heartbeat of embryo on days 26.1, 26.6 and 31.1; amnion on days 31, 31 and 30.8; limb buds on days 29.5, 28.8 and 30.6; stomach (abomasum) on days 32.2, 38.6 and 36.8; spinal column on days 32.6, 33.4 and 37.3; placentomes on days 33.3, 37 and 35.3; eyes on days 35.1, 35.4 and 38.6 and lens on days 40, 41.4 and 44. Although the mean of first day observation of all structures in heifers tends to be earlier than in the other groups, statistically, allantois, the embryo proper and its heartbeat in heifers and primipara were visualized significantly earlier than in multiparous cows. However, there were no differences between heifers and primiparous cows.     

Evaluation of knee instability in acute ligamentous injuries

The stability on clinical examination (CE) and examination under anaesthesia (EUA) was evaluated in 350 consecutive acute knee injuries. Valgus instability in knees with a medial collateral tear was observed on CE in 62 and on EUA in 67 cases (p less than 0.05). The anterior drawer sign was positive in 55 patients on CE and in 110 patients on EUA (p less than 0.0001), the corresponding figures for the Lachman test were 66 and 126 respectively (p less than 0.0001). The pivot shift-test was positive in 13 cases on CE and in 87 under anaesthesia (p less than 0.0001). Fresh total tears of the anterior cruciate ligament (confirmed at arthrotomy, n = 79) were detected by the Lachman test in 48 per cent on CE and in 96 per cent on EUA. Of the nine fresh, total tears of the posterior cruciate ligament three were disclosed by the posterior drawer test on CE and all nine on EUA. Anteromedial rotatory instability was observed on CE in 10 patients and on EUA in 47 (p less than 0.0001). In these patients 41 medial collateral tears, 23 posteromedial capsular tears, 21 medial meniscus and 40 anterior cruciate lesions were found. On CE only one anterolateral rotatory instability was found, whereas EUA disclosed 9 cases. Posteromedial rotatory instability was not confirmed on CE, though on EUA four cases were found. CE and EUA detected 2 and 3 posterolateral instabilities respectively. In conclusion, the use of EUA with an adequate mode of stability evaluation in acute knee injuries is strongly advocated. Clinical examination is considered highly unreliable with many false negative findings.     

Quantitative measurement of neurologic impairment in patients with multiple sclerosis.

Eleven patients with clinically diagnosed multiple sclerosis were simultaneously evaluated with history, physical, and neurologic evaluations and a series of objective neurophysiologic tests. Patients were then scored independently on clinical stage of their disease using a system based on symptoms in history or findings on physical or neurologic examination. Test scores on objective tests were compared with clinical scores with each evaluator. Patients with high test scores on clinical evaluation usually had high test scores on objective testing. Symptoms and physical findings were then correlated with abnormalities on objective tests. Objective abnormalities in visual evoked response and auditory evoked response on several occasions preceded the development of symptoms. All patients except for two had more than one abnormality on objective testing, suggesting a high likelihood that objective tests are helpful in the diagnosis of early-stage multiple sclerosis.     

Doctoral theses and memoirs about anesthesia. Documents for a history of Spanish anesthesia]

Based on the importance of document files and first-hand bibliographic sources for studying the history, we have recently investigated the chapter of Doctoral Thesis and Reports on anesthetic topics since we believe that these are fundamental to gain insight into the knowledge of our history. This investigation was planned to find such documents by reviewing the data of several Spanish archives and libraries. We collected 80 works: 14 Reports and 66 Doctoral Theses performed during a period of 95 years (heuristic limits 1847-1942). These papers were classified in several subgroups according to the subjects they deal with: 21 works on inhalation anesthesia, 7 on intravenous general anesthesia, 20 on spinal anesthesia, 10 on locoregional, 7 on anesthesia and metabolism, 12 on obstetric anesthesia, and 3 works on varied anesthesia issues. Analysis of these documents revealed that the authors (physicians and Spanish medical corporations) undertook an accurate consideration of the more relevant scientific subjects at the time of their investigation. We conclude that the works analyzed in the present study represented the beginning of the Spanish investigation on anesthesia. Further investigations may contribute to enrich our historiography.     

Experimental study on immunological effect of splenectomy on tumor-bearers

In view of popularity of splenectomy in combination with gastrectomy for gastric cancer, immunological effect of splenectomy was studied experimentally, using SD rats and 3-methylcholanthrene-induced mammary cancer, MRMT -1. Splenectomy was performed on day -14, 2, 7, 14 or 21 of sc inoculation of 200 mg (about 4 X 10(6) cells) of MRMT -1 at the back of 4-week-old female rats. Tumor growth and immunocompetence of peripheral lymphocytes, spleen cells and thymus cells were examined. Tumor growth on day 35 tended to be inhibited in rats splenectomized on day -14, 2, or 14, while it tended to be promoted in rats splenectomized on day 7. PHA-induced blastogenesis and NK activity of spleen cells were reduced on day 2, rose on day 7 and gradually decreased on days 14 and 21. Winn's neutralization assay revealed that spleen cells on days 2, 14 and 21 of tumor inoculation had suppressor activities. In conclusion, spleen cells of tumor-bearing rats showed a reduced immunocompetence on day 2 (the early tumor-bearing stage) and on day 14 and later (the late tumor-bearing stage), while they showed a raised immunocompetence on day 7 (the middle tumor-bearing period).     

不对称乳房美容整形治疗的探讨

目的探讨各种不同类型的不对称乳房的手术治疗方法。方法对48例不同类型的不对称乳房者，分别采用不同的乳房成形术进行矫治，其中包括两侧不同容积的乳房假体隆乳术(19例)，单侧隆乳术(11例)，切除两侧不同体积的乳房组织乳房缩小成形术(9例)，单侧乳房部分切除术(2例)，单侧乳房脂肪抽吸术(1例)，一侧巨乳房缩小成形术，一侧乳房悬吊术(3例)，一侧乳房悬吊，一侧隆乳术(2例)，单侧乳房悬吊(1例)。结果1例因乳房新皱襞下皮肤、皮下组织过多，进行了再次整复术。1例乳房悬吊术后半年，继发轻度下垂。1例因原乳腺组织切除过多且伴有乳房局部较大瘢痕，乳房前外侧稍有凹陷，形态不够满意。其余各例都取得了满意或基本满意的效果。结论对不对称乳房应针对不同的类型采用不同的术式治疗，不对称乳房的检查和测量应力求准确．以便达到尽可能的对称。     

1996 Hong Kong Renal Registry Report

Summary: This report was based on the data from the Renal Registry of the Hospital Authority of Hong Kong and accounted for approximately 90-95% of all the patients on Renal replacement therapy (RRT) in Hong Kong. Patients receiving treatment under the private sectors were not included in this report. the data were as of 31 December 1996. There were 15 renal units (2.4 unit per million population [pmp]) and four major renal transplant centres. the number of patients on RRT was 3337 (530 pmp), of which 56% (299 pmp) were on peritoneal dialysis (PD), 15% (79 pmp) on haemodialysis (HD) and 29% (152 pmp) with functioning kidney transplants (TX). the net increase in the number of patients on RRT was +12% from the previous year. the incidence of end stage renal failure was 640 (102 pmp). the median age of patients on RRT was 49 years, of which 27% were above the age of 61 years. For new patients who commenced on RRT during 1996, the median age was 56 years, of which 36% were above the age of 61 years. the causes of renal failure were glomerulonephritis 37%, unknown 30%, diabetes 13%, inherited and congenital 5%, infection/reflux 3%, hypertensive/renal vascular disease 3%, urolithiasis 2%, obstructive 1% and others 5%. For new patients entered into the programme during 1996, 25% were due to diabetic nephropathy. Ten per cent of all the patients on RRT were serologically positive for hepatitis B infection (PD 12%, HD 6%, TX 9%). 5% of all the patients on RRT were positive for hepatitis C infection (PD 3%, HD 12%, TX 7%). Seventy-nine per cent of all the patients on dialysis were on PD (1885 patients, 299 pmp), of which 96% were on CAPD. Thirty-eight per cent of the patients on CAPD were on straight-line systems, 35% on disconnecting systems and 20% on UV flash systems. Four-hundred and ninety-five patients (79 pmp) were on HD, of which 59% were on hospital based HD, 15% on satellite centre based HD, 10% on charitable centre based HD and 5% on home HD. Nine-hundred and fifty-seven patients (152 pmp) had a functioning kidney graft. 542 (57%) were transplanted in Hong Kong, of which 50% were cadaveric kidney transplantations. During 1996, 121 patients (19 pmp) received a kidney transplantation. Eighty-four transplants were performed in Hong Kong, of which 58 were with cadaveric kidneys and 26 with living related kidneys. the annual mortality rate for all RRT was 7.3% (10% for PD, 8% for HD and 1% with TX). the major causes of death were infection (28%), cardiovascular (26%) and cerebral vascular accident (9%). Outcome indicators were on patients entered into the RRT programme during 1995, thus allowing for 1 year of follow up. For CAPD as the first RRT, 1 year patient and technique survival (censored for death and non-technique failure) were 94% and 93%. For living related kidney transplants performed in Hong Kong, 1 year patient and graft survival (censored for death) were both 100%. For cadaveric kidney transplants, 1 year patient and graft survival were 98% and 96%     

Urinary tract anomalies detected in prenatal diagnosis]

Advances and spread in ultrasonography in obstetrics have resulted in the increase in the number of reports of congenital anatomical anomalies that have been diagnosed prenatally. We present 56 patients with congenital urinary tract anomalies, which were found by prenatal USG. These anomalies included pelvi-ureteric junction stenosis in 19, multicystic kidney in 12, primary megaureter in 6, ureterocele in 4, posterior urethral valve in 3, polycystic kidney in 2, vesicoureteral reflux in 2, urogenital sinus anomaly in 2 and others in 4. There were 9 oligohydramnios: posterior urethral valve in 2, polycystic kidney in 2, bilateral multicystic kidney in 2, urogenital sinus anomaly in 2 and vesicoureteral reflux in 1. In the neonatal period, urological treatment was performed on 13 patients; indwelling catheter on 4, vesicostomy on 2, ureterocutaneostomy on 2, TUR cele on 2 and others on 3. Among the cases, 25 have been operated on after the various intervals of follow-up periods. Pyeloplasty was performed on 9 patients with pelvi-ureteric junction stenosis, total reconstriction on 4 with ureterocele, ureterocystoneostomy on 3 with megaureter and others on 9. There were 7 lethal cases; polycystic kidney in 2, multicystic kidney in 2, posterior urethral valve in 1, megaureter in 1 and urogenital sinus anomaly in 1. It seems likely that various kinds and increasing number of urinary tract abnormalities will be diagnosed through prenatal USG. It is now important to make a consensus for the timing and management of the therapy of these anomalies.     

Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers

We investigated the effect of pressure application on the acupuncture point "extra 1" and on a control point on the bispectral index (BIS) values and on stress in 25 volunteers. In each volunteer, pressure was applied on the extra 1 point for 10 min and on a control point for 5 min on different days and in a randomized manner. The BIS value was recorded before applying pressure on the extra 1 point, during pressure application every 30 s for 10 min, and after pressure release. Regarding the control point, BIS values were recorded for 5 instead of 10 min during pressure application because acupressure on that point was associated with an unpleasant feeling. Each volunteer was asked to score stress before and after pressure application from 0 to 10. The BIS values were significantly reduced 2.5, 5, 7.5, and 10 min during pressure application on the extra 1 point (P < 0.001 for each comparison, respectively) and returned to the baseline values after pressure release. Pressure application on the control point decreased BIS values (P < 0.01 and P < 0.05 at 2.5 and 5 min, respectively). However, these values were maintained close to 90% and were significantly higher than those obtained during pressure on the extra 1 point (P < 0.001 and P < 0.001 for the 2.5- and 5-min comparisons). The verbal sedation score values obtained after pressure application on the extra 1 point were also lower when compared with the values obtained after pressure application on the control point (P < 0.001). IMPLICATIONS: This crossover study investigated the effect of pressure application on the acupuncture "extra 1" point in healthy volunteers. Acupressure applied for 10 min on the extra 1 point significantly reduced the BIS values and the verbal stress score when compared with acupressure applied on a control point.     

Neuromuscular monitoring

This review summarizes recent reports on the techniques and the use of methods for monitoring neuromuscular function during anaesthesia. The latest news on the use of acceleromyography in the face and hand, on laryngeal and diaphragmal surface electromyography, on acoustic myography, on evaluation of intense neuromuscular block, and on postoperative residual curarization is presented and discussed. It is concluded that available evidence suggests that more attention should be paid by the anaesthetist to the problems of residual curarization and hence to proper monitoring of neuromuscular function using objective methods.