Anatomical analysis of the human lacrimal drainage pathway under an operating microscope

Mesoscopic structures of the lacrimal drainage pathway were observed under an operating microscope in six cases of 5 adult cadavers. In all these cases the upper and lower canaliculi fused to form the common canaliculus. Two cases with a large common canaliculus showed large projections of mucosa which reduced the inner space of the common canaliculus. The remaining 4 cases with a small common canaliculus did not show any projections. These findings indicate that the human lacrimal system can function physiologically through a small narrow space of the common canaliculus.Abbreviation DSI direct silicone intubation     

Prognosis of the patients with high grade bladder carcinoma

The pathological features and clinical outcome of grade 3 transitional cell carcinoma of the bladder, excluding CIS, encountered between 1972 and 1988 were studied to clarify the clinical characteristics of the disease. The subjects of this study were 108 patients consisting of 76 males and 32 females aged 33-87 years, with a mean age of 66 years. The survival rate according to each factor was calculated by Kaplan-Meier method, and the survival curves were compared by generalized Wilcoxon test. Grade 3 bladder cancer was often papillary, sessile and about 3 cm in diameter and showed a tendency of multiple occurrence. Histopathologically, it was often in high stages of pT2 or above and frequently with vascular invasion. Total cystectomy is not considered to be an absolute necessity for pT1, G3 bladder cancer patient, because, in our experience, it did not improve the prognosis. However, bladder-preserving operation requires strict postoperative follow-ups. After this operation, the 5-year survival rate was higher in the no-recurrence group than in the recurrence group, and the out come tended to be better in the group that had undergone intravesical instillation chemotherapy for prevention of recurrence than in the group without this therapy. Ample intravesical instillation chemotherapy after bladder-preserving operation seems to improve the postoperative course of bladder cancer patients. Total cystectomy may be unavoidable in patients with pT2 or above, and no effect of postoperative adjuvant chemotherapy was noted in our series. The establishment of multidisciplinary approaches is considered to be needed for improvement of the prognosis of high stage bladder cancer.     

Far-field recording of the junctional potential generated by median nerve volleys at the wrist

In 20 arms from 10 healthy subjects, the orthodromic median sensory volleys crossing the wrist gave rise to a stationary, biphasic potential rendering the forearm initially positive (Pw) and subsequently negative (Nw) compared with the hand. A pair of electrodes located on each side of the wrist best detected the junctional potential, Pw-Nw, that developed across the partition. Here the hand and the forearm each, in effect, acted as a lead, connecting any points within the respective compartment to the voltage source. Thus, nearly the same potential difference appeared across the wrist regardless of the inter-electrode distance, allowing the detection of the voltage step in far-field derivation. Our data verify that not only positive but also negative peaks of scalp-recorded evoked responses could represent junctional potentials generated along the course of the conduction medium in the absence of fixed neural discharges.     

Phase-transfer catalysis of phosphonium ions derived from poly[(P-phenyl)trimethylenephosphine]

Polymeric phosphonium ion species having different content of phosphonium units ( 4a and 4b ) were prepared from poly[(P-phenyl)trimethylenephosphine] ( 3 ). Phase-transfer catalysis of 4 was examined by means of a typical S_N2 reaction (1) in a bi-phase system. The apparent rate constant (k_obs) was determined, its magnitude being smaller by about one order than that of the corresponding monomeric phosphonium ion 5 . Crosslinked polymeric phosphonium ion species were coated on powdery alumina and used as a phase-transfer catalyst for reaction (1) in a triphase system. Due to the inhomogeneous reaction, the k_obs value was much smaller (1/5) than that in presence of 4 .     

Interruption of the aortic arch associated with deletion of chromosome 22q11 is associated with a subarterial and doubly committed ventricular septal defect in Japanese patients.

OBJECTIVES: The purpose of this study was to clarify the clinical characteristics of interruption of the aortic arch associated with chromosome 22q11deletion. BACKGROUND: About half of patients with interruption of the aortic arch between the left common carotid and the left subclavian artery have deletion of chromosome 22q11. METHODS: In total, 20 patients with interruption of the aortic arch were studied with fluorescence in situ hybridization using peripheral lymphocytes and a DiGeorge syndrome chromosomal probe (Oncor N25). Cardiovascular anomalies in these patients were diagnosed by cross-sectional echocardiography and angiocardiography, and were confirmed at intracardiac repair. RESULTS: Of 13 patients with interruption between the left common carotid artery and the left subclavian artery, seven had the deletion. All 7 also showed thymic hypoplasia and hypocalcemia, together with a nasal voice and peculiar facies. Six of the seven patients had complete deficiency of the muscular outlet septum, with the defect extending to the perimembranous area. Such complete absence of the muscular outlet septum was not present in any of the patients without the deletion. CONCLUSIONS: Interruption of the aortic arch between the left common carotid and the left subclavian artery, absence of the thymus, and complete absence of the muscular outlet septum, were characteristic in Japanese patients with interruption of the aortic arch associated with deletion of chromosome 22q11.     

A diary form quality of life questionnaire for Japanese patients with lung cancer and summarization techniques for longitudinal assessment

The aim of this study was to confirm the validity and reliability of a new diary-type quality of life (QOL) self-rating questionnaire tailored for use by Japanese inpatients with lung cancer receiving chemotherapy. Two kinds of summary statistics were tested in QOL analysis. The questionnaire has a four-scale structure; physical, psychological, daily activity and global scales. Fifty-three patients were enrolled to test the reliability and validity. Summary statistics were assessed using indices of the area under the curve (AUC) and the maximum fluctuations of QOL scores (Dif max) in patients receiving cisplatin or carboplatin. The questionnaire had satisfactory reliability and validity. The physical, psychological and global scales scores changed to the worst levels after treatment, continuing for 1 week in the cisplatin group, whereas those of the carboplatin group began to worsen from day 3, but returned to prechemotherapy levels by day 9. The cisplatin group showed significant decrease of QOL compared with the carboplatin group in the AUC of psychological and two global scales, in the Dif max of psychological and linear analogue global scales. These results suggested that this questionnaire reflects differences in the influence of chemotherapy, and that AUC and Dif max may be useful indices for the analysis of QOL as measures to assess multidimensional QOL.     

Clinical studies of cefoperazone in neurosurgery

A multicenter trial consisting of 164 institutions through out Japan, has been conducted to study the transfer of cefoperazone (CPZ) into the cerebrospinal fluid (CSF), and the clinical effectiveness of CPZ as a therapeutic or prophylactic agent in neurosurgery. The levels of CPZ in serum and CSF were determined in 96 patients. After initial dose of 2 g CPZ (intravenous drip infusion for 30 minutes), the serum level of CPZ after 1 hour was 124.5 +/- 6.6 micrograms/ml (Mean +/- S.E.), and even after 6 hours, it maintained as high as 47.8 +/- 16.6 micrograms/ml. The peak CPZ levels in CSF in patients with normal or minimal impairment in blood-CSF-barrier (BCB) (group I) and in those of localized impairment in BCB (group II) were 1.0 +/- 0.5 micrograms/ml at 2 hours and 3.0 +/- 1.8 micrograms/ml at 3 hours, respectively. The highest CSF level was seen in patients with meningitis (group III) and showed 5.0 +/- 2.4 micrograms/ml at 6 hours. After multiple dose of 2 g CPZ (intravenous drip infusion for 30 minutes), the serum kinetics of CPZ were not significantly different from those obtained after initial dose. However, the CPZ levels in CSF were higher than those observed after initial dose in all 3 groups and were higher than MIC75 against relevant pathogens for meningitis such as Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. Moreover, in group III peak level of CPZ in CSF exceeded the MIC75 against Pseudomonas aeruginosa which is also frequently isolated from patients with meningitis in neurosurgery. As a therapeutic agent CPZ administered as sole agent was effective in 42 out of 55 cases (76.4%) in meningitis, in 78 out of 116 cases (67.2%) in pneumonia and in 36 out of 47 cases (76.6%) in urinary tract infection (UTI). Its efficacy rate against all infections treated was 72.2% (184/255). Regarding CPZ's prophylactic use, 39 out of 514 cases (7.6%) were judged as having or possibly having infections as follows; meningitis (13/514, 2.5%), pneumonia (15/514, 2.9%), UTI (2/514, 0.4%). In prophylactic use of CPZ, the incidence rates of postoperative meningitis and other central nervous system (CNS) infection following ventricular drainage and supratentorial craniotomy for aneurysm were higher than those observed in other types of operation, 12.0% (3/25) and 6.2% (8/130), respectively. Also, regarding prophylactic use of CPZ, the organisms isolated by culture from 13 cases of postoperative CNS infections included 2 strains of Staphylococcus sp., 1 strain of Serratia sp. and 3 strains of other Gram-negative bacteria (GNB).(ABSTRACT TRUNCATED AT 400 WORDS)     

EEG polygraphic sleep study in divers under a 31 ATA He-O2 environment with special reference to the automated analysis of sleep stages

This study was performed on four simulated professional divers (31 ATA, PO2 = 0.4 bar, PN2 = 0.79 bar) to investigate the function of their sleep polygraphically. All-night electrographical recording of the subjects' sleep was taken from 23:00 until 07:00 the next morning, predive, saturation, decompression, and postdive from Nov. 20 to Dec. 13, 1985. Polygraphic analysis of nocturnal sleep was done by a microcomputer technique developed by us for comparison with visual scoring. This system is a real-time processing system. Therefore, a sleep chart is completed when the experiment is finished. This system was very useful for the analysis of the tremendous volume of sleep records during a nearly one-month experiment. The following results were obtained: In the predive control, total amount of stages (3 + 4) of NREM and REM sleep decreased. In the hyperbaric environment at 31 ATA, all the divers had to interrupt their sleep once or twice for nocturnal sleep urination, and also total waking time increased during nocturnal sleep. At 31 ATA, the length and the cycle of the sleep profile vacillated. A high degree of correlation was observed between the sleep profile recorded by the polygraph and the subjective appreciation of sleep.