Prognostic implications of nasal cavity and cleft morphology in secondary bone grafting.

OBJECTIVE: To examine the prognostic significance of the skeletal morphology around the nasal cavity and the alveolar cleft in secondary bone grafting (SBG). DESIGN AND SETTING: Fifty-one alveolar clefts in 41 patients (10 bilateral and 31 unilateral cleft lips and palates) registered in the Tokushima University Dental Hospital were examined in this study. METHOD: Evaluation of the bony bridge after SBG using dental radiographs at 1 year after surgery. The clefts were divided into two groups: group I (54.9%) in which the upper border of the bony bridge was preferably maintained on or above the horizontal reference line (RL) constructed at the level of the root apex of the upper central incisor adjacent to the cleft, and group II (45.1%) in which the bone level was lower than the RL. Presurgical cleft width was determined by the dental radiographs. The cleft/nasal cavity ratio; the value of the cleft width divided by the nasal cavity width on the cleft side, which was analyzed by frontal cephalograms before the SBG; and the cleft/apertura piriformis ratio, the value analyzed by computed tomography, were used. RESULTS AND CONCLUSION: The age, sex, and eruptive stage of the canine teeth at the time of the SBG showed no significant difference between groups. The presurgical cleft width also showed no significant difference between group I (6.6 +/- 3.1 mm) and group II (7.9 +/- 3.3 mm). The cleft/nasal cavity ratio showed a significant difference between groups I and II (0.42 +/- 0.14, 0.75 +/- 0.25; p < .05). Furthermore, the cleft/apertura piriformis ratio also showed a significant difference between groups I and II (0.32 +/- 0.12, 0.65 +/- 0.26; p < .05). These results suggested that measurements of the skeletal morphology around the nasal cavity and alveolar cleft might aid in predicting the stability of the bony bridge after SBG.     

Ventricular Late Potential in Patients with Apparently Normal Electrocardiogram; Predictor of Brugada Syndrome

Backgrounds: Brugada syndrome can be overlooked due to its dynamic change in its electrocardiogram (ECG) manifestation. We hypothesized that positive ventricular late potential (VLP) in patients with nonspecific ECG would predict the inducible coved ST elevation (type‐1 Brugada ECG) and the patients at high risk. Methods: Thirty‐four patients of nonspecific ECG without structural heart disease were eligible for this study. All patients were referred for evaluation of syncopal episodes and/or cardiac arrest and/or frequent episodes of ventricular premature contractions. We assessed the correlation between baseline VLP and the alteration to a drug‐induced type‐1 Brugada ECG, and also evaluated the diagnostic accuracy of positive VLP in normal ECG subjects for the appearance of a drug‐induced type‐1 Brugada ECG. Results: Twenty‐one patients presented positive VLP and 13 patients showed negative VLP. Parameters of VLP (fQRSd, RMS₄₀, LAS₄₀) presented significant correlation with the alteration to a type‐1 ECG by pilsicainide. VLP demonstrated high sensitivity and negative predictive value for the prediction of type‐1 Brugada ECG. Furthermore, in their follow‐up, at least two cases of ventricular fibrillation were recognized in 21 of positive VLP patients with apparently normal ECGs. Conclusions: VLP in apparently normal ECG can predict the alteration to a drug‐induced type‐1 Brugada ECG and unmask the patients at risk. (PACE 2010; 33:266–273)     

A case of metastatic tumor of spermatic cord from renal cell carcinoma

A 51-year-old man was admitted with the complaint of left scrotal swelling (11 x 5 x 5 cm). He had undergone left nephrectomy and removal of tumor thrombus in inferior vena cava due to renal cell carcinoma. Nine months after the nephrectomy, left scrotal enlargement was noticed. Left high orchiectomy was performed on January 20, 1988. A clear cell carcinoma was present in spermatic cord and pampiniform plexus histologically but testis and epididymis were intact. Renal cell carcinoma seemed to disseminate retrograde through the spermatic vein to spermatic cord. The metastatic tumor of spermatic cord from renal cell carcinoma is very rare and this case is the fifth case in the Japanese literature.     

Prediction of hepatic first-pass metabolism and plasma levels following intravenous and oral administration of barbiturates in the rabbit based on quantitative structure—Pharmacokinetic relationships

Based on the concept of physiological pharmacokinetics, the hepatic first-pass metabolism and plasma levels following intravenous and oral administration of barbiturates in the rabbit was predicted based on the relationships between principle kinetic parameters and lipophilicity (chloroform-water partition coefficient). Good log-log linear relationships between kinetic parameters and lipophilicity were obtained for the seven barbiturates examined. The values of correlation coefficient were improved slightly by using the corrected values for partition coefficients of nonionic molecules in the cases of principle parameters such as drug-protein and drug-blood cell affinity, intrinsic hepatic clearance, and unbound volume of distribution. There was also a good linear relationship between absorption rate constant (mean absorption time) and lipophilicity. The mean hepatic transit time was negligible for the most lipophilic drug (hexobarbital) examined; this suggests that the mean absorption time for these barbiturates does reflect the absorption process. The available fraction in relation to hepatic first-pass metabolism was well predicted from the lipophilicity by both well-stirred and parallel-tube models, and the difference in the values predicted by both models was minimal. There were good relationships between predicted and observed values for plasma levels after intravenous and oral administration, except for two (cyclobarbital and phenobarbital) of the seven drugs used. The great difference between predicted and observed values for these two drugs was considered due to substituent effects in liver metabolism.     

Computed tomography for the assessment of pelvic lymph node metastasis in cases of uterine cervical carcinoma

Seventy-six patients with cervical cancers underwent preoperative abdominopelvic computed tomography before a pelvic lymphadenectomy to evaluate the efficacy of computed tomography in assessing pelvic lymph node metastases. The sensitivity and the specificity of computed tomography for detecting pelvic lymph node metastases were judged to be 70.6 and 89.8%, respectively. In 54 patients in stage Ib or IIa of the disease, the sensitivity and specificity were 85.7 and 91.5%, respectively. Although inaccuracies could be caused by normal-sized metastasized lymph nodes and by enlarged lymph nodes with reactive hyperplasia, computed tomography was found to be a useful method of detecting a pelvic lymph node metastasis.     

Is mythical delusion a factor blocking schizophrenic symptoms?

Abstract It has been stated that mythical delusion can block schizophrenic symptoms. However, there are some schizophrenics in whom mythical delusion does not react against schizophrenic symptoms. Three cases are reported of mythical delusion and what conditions are necessary for the mythical delusion to "block" schizophrenic symptoms are considered. Such 'blocking' can be found in the mythical delusion which mediates between schizophrenic symptoms and reality. Conversely, when there is no relationship between mythical delusion and schizophrenic symptoms 'blocking' cannot be expected.     

Immunohistochemical evidence of insulin-like growth factor II in human small hepatocellular carcinoma with hepatitis C virus infection: Relationship to fatty change in carcinoma cells

It has recently been reported that insulin-like growth factor II (IGF-II) may play a role in the pathogenesis of hepatocellular carcinoma (HCC). We studied the relationship between the expression of IGF-II and fatty change in human small HCC using immunohistochemical staining techniques. Liver biopsy specimens were obtained from 35 patients with HCC (consisting of 15 patients with fatty change and 20 patients without fatty change). All patients had serum markers for the hepatitis C virus (HCV) and histological findings obtained from non-tumourous lesions showed liver cirrhosis or chronic active hepatitis. Immunohistochemical staining was performed using a monoclonal antibody against rat IGF-II. A positive immunoreaction was found in 69% (24/35) of HCC. Insulin-like growth factor II was immunodetected in 80% (12/15) of HCC with fatty change but only in 60% (12/20) of those without fatty change. In most cases, IGF-II was not found in hepatocytes from non-tumourous lesions. We believe this to be the first time that IGF-II has been detected immunohistochemically in small HCC derived from HCV infection. This growth factor was more frequently immunodetected in HCC with fatty change than without. As insulin is an essential factor for the metabolism of fatty acids, IGF-II may play an important role in both fatty degeneration and in the proliferation of HCC cells. Furthermore, immunohistochemical IGF-II staining may contribute to the diagnosis of HCC, particularly in early stages accompanied by fatty change.