Do Sacral/Peripheral Lesions Contribute to Detrusor‐Sphincter Dyssynergia?

Objectives: While detrusor‐sphincter dyssynergia (DSD) occurs in conjunction with lesions between the brainstem and the sacral cord, it is not well known whether sacral/peripheral lesions contribute to DSD. We studied the relationship between DSD and sacral/peripheral lesions. Methods: One hundred and forty‐four patients with diverse neurologic etiologies underwent urodynamic study and analysis of motor unit potentials in the external sphincter muscles, 117 of whom were able to void during a urodynamic test. Sacral/peripheral lesion (SPL) is defined as neurogenic change in motor unit potentials. Detrusor overactivity (DO) is defined as involuntary detrusor contractions during the filling phase, which commonly occurs in lesions above the sacral cord. We considered DO as a putative indicator of supra‐sacral lesion. Results: DSD was found in 44 (30.6%), SPL in 71 (49.3%), and DO in 83 (57.6%) of 144 patients, respectively. The incidence of DSD was the same in the SPL positive group (31%) and the SPL negative group (30.1%). By contrast, within the subgroup of patients without DO, the incidence of DSD was significantly more common in the SPL positive group (41.4%) than in the SPL negative group (25.0%) (P < 0.05). In 53 of the SPL positive group who were able to void, postvoid residual >100 mL was more common in patients with DSD (not statistically significant). Conclusion: The results of the present study suggest that not only suprasacral pathology, but also sacral/peripheral lesions can produce DSD. In light of the previous reports, DSD might also result from partial lesions in peripheral branches of the sphincter circuit.     

Indocyanine Green Fluorescence Endoscopy at Endonasal Transsphenoidal Surgery for an Intracavernous Sinus Dermoid Cyst: Case Report

The complete resection of intracavernous sinus dermoid cysts is very difficult due to tumor tissue adherence to important anatomical structures such as the internal carotid artery (ICA), cavernous sinus, and cranial nerves. As residual dermoid cyst tissue sometimes induces symptoms and repeat surgery may be required after cyst recurrence, minimal invasiveness is an important consideration when selecting the surgical approach to the lesion. We addressed a recurrent intracavernous sinus dermoid cyst by the endoscopic endonasal transsphenoidal approach assisted by neuronavigation and indocyanine green (ICG) endoscopy to confirm the ICA and patency of the cavernous sinus. The ICG endoscope detected the fluorescence signal from the ICA and cavernous sinus; its intensity changed with the passage of time. The ICG endoscope was very useful for real-time imaging, and its high spatial resolution facilitated the detection of the ICA and the patent cavernous sinus. We found it to be of great value for successful endonasal transsphenoidal surgery.     

Coronary Artery Spasm Induced by Ergonovine in an Infarct Related Coronary Artery Late After Primary Angioplasty

We report two cases with induced coronary spasm of the culprit lesion in the infarct related coronary artery in the chronic phase after primary percutaneous transluminal coronary angioplasty (PTCA). To our knowledge, there are few data on the response of the angioplasty site to ergonovine in human coronary arteries after primary PTCA. It is important to note that chest pain recurring after successful primary PTCA is not automatically related to restenosis, and coronary spasm in patients with previous myocardial infarction, should also be considered . (J Interven Cardiol 2000;31–34)     

Preserved priming but insensitivity to perceptual fluency on recognition judgments in Alzheimer's disease

Background: Previous research on Alzheimer's disease (AD) has not yielded a consensus regarding the preservation of automatic memory processes, although there is a consensus that conscious recollection processes are impaired in AD. Methods: In the present study, we examined perceptual specificity effects (PSEs) in word recognition judgments (explicit memory task; Experiment 1) and word fragment completion (implicit memory task; Experiment 2) performed by individuals with mild AD and elderly adults without dementia (controls). Results: In recognition judgments, control subjects, but not individuals with AD, demonstrated PSEs (Experiment 1). In contrast, neither group showed PSEs on word fragment completion and their priming magnitudes were comparable (Experiment 2). Conclusions: The findings suggest that perceptually automatic processes in explicit memory judgments and implicit memory processes are different and that the former are specifically impaired in AD.     

Portless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: Experience with initial 30 cases

AIM: To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. METHODS: For 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3-9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), non-functioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). RESULTS: Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5-470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. CONCLUSIONS: Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery.     

Genetic control of immune responses to Schistosoma japonicum antigen

A high-titre IgE-antibody response to Schistosoma japonicum antigen (Sj) is obtained if helper T cells are appropriately induced by the infection. The antibody responses were found to be regulated by a gene(s) linked to the major histocompatibility complex. Strains of H-2a and H-2k haplotypes were high responders, whereas H-2d, H-2b and H-2s strains were not. Results obtained by using intra-H-2 recombinant strains suggested that the immune-response (Ir) gene was mapped in the I-E subregion, although a possibility of the presence of complementary genes was not excluded. Interestingly, in low responders such as BALB/c mice, Sj-specific carrier effect could be demonstrated when mice were infected with S. japonicum before challenge immunization with dinitrophenylated Sj (DNP-Sj). Moreover, BALB/c as well as C3H/He was a high responder to Sj in proliferation of peritoneal exudate T-lymphocyte enriched cells in vitro, whereas B10.S was not. Based on these observations, possible roles of Ir genes in immune responses to Sj are discussed.     

传染病病原体洗消关键技术研究现状和发展趋势

从洗消剂、洗消方法和洗消装备3个方面介绍了国内外病原体洗消关键技术的研究现状,并指出高效能、低腐蚀、无污染将成为今后洗消剂发展的主要趋势;高温、高压、射流等多种洗消手段复用代表了当今洗消装备的国际水平和发展趋势;多功能、智能化、模块化、防污染、体系化是洗消装备的主要发展方向。     

Prevalence of metabolic complications in children with severe obesity

BACKGROUND: The purpose of the present paper was to clarify the prevalence of metabolic complications in severely obese children. METHODS: The subjects of the present study were 367 severely obese Japanese children in Tokushima, who were more than 150% of the standard weight for their sex and height (school grades 1-9; age range, 6-16 years). Data concerning anthropometric and metabolic parameters (body fat %, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, blood glucose, serum insulin, alanine aminotransferase, and blood pressure) were analyzed. RESULTS: The prevalence of each abnormality in obese children was high compared with that in the general population. Metabolic variables were correlated with each other. A total of 80.4% of severely obese children had at least one complication. CONCLUSION: Severely obese children have various metabolic abnormalities even during their early school years. Intervention by primary physicians in cooperation with schools is needed for the prevention of lifestyle-related diseases.     

Association of mutations in the core promoter and precore region of hepatitis virus with fulminant and severe acute hepatitis in Japan

It was recently reported that mutations in the precore and core promoter region of hepatitis B virus (HBV) are associated with fulminant hepatitis. The aim of this study was to investigate the association of mutations in the precore and core promoter region of HBV with fulminant and severe acute hepatitis. We studied Japanese patients with acute HBV infection, including seven patients with fulminant hepatitis, 12 with severe acute hepatitis and 41 with acute self-limited hepatitis. The presence of HBV mutants was examined by using a point mutation assay to detect a G to A transition at position 1896 in the precore region and an A to T transition at position 1762 and a G to A transition at position 1764 in the core promoter region. Significant differences in the proportion of mutations in the precore or core promoter region were present between patients with fulminant hepatitis and self-limited acute hepatitis (7/7 (100%) vs 4/41 (9.8%), P < 0.01) and between severe acute hepatitis and self-limited acute hepatitis (6/12 (50.0%) vs 4/41 (9.8%), P < 0.01). The frequency of mutation increased proportionately with the severity of disease in patients with acute HBV infection. Fulminant hepatitis B in Japan is closely associated with mutations in the core promoter and precore gene of HBV. Point mutation assays for HBV precore and core promoter analysis may be useful to predict the outcome of liver disease in patients with acute HBV infection.     

Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.