Survey of preoperative cardiology consultation

Cardiology consultations are often requested preoperatively for patients with cardiovascular problems. However, there are frequently differences in the evaluation of preoperative cardiac risks among cardiologists, surgeons and anesthesiologists. In order to obtain possible solutions to this problem, we conducted a survey of preoperative cardiology consultations performed directly by cardiologists. The survey indicates a lack of interaction with anesthesiologists and insufficient information on the surgical procedures and anesthesia for cardiologists to assess compromising cardiac risks. In addition, many cardiologists suggested that exercise tolerance required for surgical procedures should be 7 METs or more for surgical patients.     

Dependence of vibrotactile thresholds on the psychophysical measurement method

OBJECTIVES: To investigate the dependence of vibrotactile thresholds on the psychophysical method used in the diagnosis of neurological dysfunction caused by exposure to hand-transmitted vibration. To compare thresholds obtained with (a) 'continuously variable' versus intermittent 'staircase' stimulation using 'yes-no' responses, and (b) 'yes-no' and 'forced-choice' responses using intermittent staircase stimulation. METHODS: Vibrotactile thresholds were measured on 12 healthy men by three different psychophysical methods. All measurements were performed with the same vibrometer in which the vibratory stimulus was applied by a probe 6 mm in diameter that protruded through a hole of 10 mm diameter in a surround, controlling both the contact force and the push force. Four stimulus frequencies (16, 31.5, 63 and 125 Hz) were used to obtain responses from FAI and FAII mechanoreceptors. RESULTS: There was a 3 to 6 dB variation in threshold due to the psychophysical method: thresholds were lower with intermittent stimulation and thresholds obtained with the 'forced-choice' procedure were lower than those obtained with the 'yes-no' procedure. Alternative explanations of the findings were offered. CONCLUSIONS: The dependence of psychophysical measurement method on vibrotactile thresholds was partly due to influencing responses via mechanoreceptor systems. It was suggested that the psychophysical measurement method had a sufficiently large effect on vibrotactile thresholds for it to be taken into account when methods for the diagnosis of neurological disorders are standardised.     

Prognostic factors in elderly patients with acute myelogenous leukemia: a single center study in Japan

We retrospectively analyzed data of 47 patients aged 60 years or older, hospitalized in our institution with the diagnosis of acute myelogenous leukemia (AML), and searched for prognostic factors. Induction with anthracyclines significantly correlated with better complete remission (CR) rate (P = 0.0016) and overall survival (OS) (P < 0.001). Another factor significantly affecting CR rate was higher age (> 70 years) (P = 0.042). Therapy-non-related factors predictive for shorter OS in univariate analyses were age older than 70 years (P = 0.003), percentage of blasts in bone marrow more than 80% (P = 0.048), serum lactate dehydrogenase level higher than 250 U l(-1) (P = 0.032). In stepwise cox proportional hazard regression model, all the four factors predictive for poor OS remained to be independently and significantly prognostic for shorter OS. Only two patients receiving anthracyclines died within 30 days and the frequency was not different from that in patients not receiving anthracyclines. The use of anthracyclines as induction therapy is recommended even in the elderly patients.     

Pulmonary alveolar proteinosis as a terminal complication in myelodysplastic syndromes: a report of four cases detected on autopsy

Secondary pulmonary alveolar proteinosis (PAP) is one of the complications of hematologic malignancy and immunosuppressive diseases. We encountered four cases of myelodysplastic syndrome (MDS) associated with PAP detected on autopsy. They consisted of two refractory anemia (RA) and two patients with refractory anemia with excess blasts in transformation (RAEBt) at the time of MDS diagnosis, but all of them developed leukemic phase and were resistant to chemotherapy at the time of pulmonary episodes. Of the four MDS patients, two also had pulmonary aspergillosis. Previously, 69 patients with PAP associated with hematologic disorders have been reported, but there have been only seven cases with MDS, including our four patients. Of the 69 reported cases of PAP in hematologic malignancies, 24/63 (38%) informative patients with infection had fungal infections of the lung; 2/7 (29%) MDS cases had fungal infection. We should, therefore, pay careful attention to this possibility in cases of MDS with lung complications, including PAP, especially in patients in the leukemic phase of MDS.     

The evaluation of lateralized frontal lobe function in the patients with autistic or attention deficit/hyperactivity disorder

The prefrontal lobes are involved in two functionally distinct cognitive selection mechanisms: processing based on internal representation, such as planning (context-dependent reasoning) and exploratory processing of novel cognitive situations (context-independent reasoning). On the basis of this working hypothesis, a cognitive bias task (CBT; Goldberg, 1994), designed as an activation procedure representing contextual reasoning, was used to explore developmental disorders of lateralization in the frontal lobes in autistic disorder and attention deficit/hyperactivity disorder (ADHD). The subjects included 3 patients with autistic disorder, 4 with ADHD. Ten normal right-handed males served as controls. In CBT, a high score indicated consistency of choice: a context dependent selection bias, and a low score showed independent selection bias. The autistic group showed a score significant lower than those in controls (p < 0.01). The ADHD group had also a lower score. These findings implicate a deficit in the development of hemispheric specialization in the symptoms of these developmental disorders.     

Monoclonal antibody to stage-specific fetal brain 68-kDa glycoprotein (FGP68) revealed increased FGP68 expression in human primary brain tumors

We have produced a novel rat IgG(2a) monoclonal antibody against a stage-specific fetal brain glycoprotein of 68 kDa (FGP68), and succeeded in applying it to staining paraffin sections. To gain some insight into the pathobiological significance of this FGP68, this monoclonal antibody was used in immunohistochemical studies to compare the expression of FGP68 and Ki-67 antigen (MIB-1) in 235 primary brain tumors. Approximately half of the glioblastomas multiforme (GBMs) (44/75) and anaplastic astrocytomas (9/17) as well as some astrocytomas (5/30), medulloblastomas (2/14) and primitive neuroectodermal tumors (2/10) had tumor cells that expressed FGP68; however, pilocytic astrocytomas (0/7), oligodendrogliomas (0/15), ependymomas (0/6), schwannomas (0/21), meningiomas (0/22) and pituitary adenomas (0/18) did not express FGP68. The values of the MIB-1 labeling index were statistically higher in GBMs (0.005< P<0.01, Wilcoxon rank-sum test) and anaplastic astrocytomas (0.025< P<0.05) that expressed FGP68 than in those that did not. Normal brain tissue from 20 individuals aged 3-75 years was negative for FGP68 and MIB-1. We conclude that primary brain tumors express FGP68, one of the oncofetal proteins derived from fetal brain, and that FGP68 expression in certain brain tumor cells may depend, in part, on proliferation potential. Based on the possibility that the stage-specific FGP68 plays an important role in brain embryogenesis, some of FGP68-expressing tumor cells might phylogenetically revert to more primitive cells.     

Neuropilin-2 is overexpressed in the rat brain after limbic seizures

Structural rearrangement and synaptic reorganization are known to occur in the brain after seizures. If neuronal rearrangement after seizures always results in abnormal hyperexcitability, it would provide an accurate pathway to the appropriate target and as a result, it may be the mechanism of epileptogenesis. This study examined the mechanism of axon guidance in the mature rat brain after seizures by evaluating the expression of the axonal guidance molecule, neuropilin-2. We assessed the expression of neuropilin-2 by northern blotting and immunohistochemistry in rat with seizures created by kindling stimulation and kainate injection.The neuropilin-2 mRNA level was increased in the whole brain of the rats at 24 h after either type of seizure. Neuropilin-2 mRNA was not increased at 2 weeks after the last stimulation. Immunohistochemistry demonstrated that neuropilin-2 protein was increased in the dentate gyrus and the entorhinal cortex in the both seizure models. These findings suggested that there was overexpression of neuropilin-2 in the brains of mature rats with different types of seizure. Accordingly, neuropilin-2 might regulate remodeling after seizures as it does during the development of the hippocampal formation. Our findings suggest that axons may not project and outgrow 'aberrantly' after seizures, but may be regulated by the chemorepellent effect through neuropilin-2.     

Rat small intestinal goblet cell kinetics in the process of restitution of surface epithelium subjected to ischemia-reperfusion injury

Repair of superficial damage to gastrointestinal mucosa occurs by a process called restitution. Goblet cells reside throughout the length of the intestine and are responsible for the production of mucus. However, a kinetic analysis of goblet cell dynamics of small intestine in restitution has hitherto not been reported. The aim of the present study was to investigate the role of goblet cells in the process of restitution of rat small intestine subjected to ischemia and ischemia-reperfusion injury, and therefore intestinal epithelium from rats subjected to both ischemia and ischemia-reperfusion was studied. Detachment of enterocytes was observed after 5-min of reperfusion. After 20-30 minutes of reperfusion, the denuded villous tips were covered with goblet cells. Within 75 min of reperfusion the epithelium restitution was complete. On the other hand, restitution was not observed in ischemia group. These data suggest that goblet cells may play an important role in restitution after ischemia-reperfusion injury.     

Multislice CT angiography through an implantable catheter and port system: early experience in detection of vascular complications during hepatic arterial infusion chemotherapy

OBJECTIVE: The purpose of this study was to evaluate the use of multislice CT in the evaluation of vascular patency in patients during hepatic arterial infusion chemotherapy of liver tumors. MATERIALS AND METHODS: Thirty-three patients were prospectively examined by CT angiography through the indwelling catheter and port system. Visibility of hepatic arteries and vascular patency were graded 0 to 3 and were compared with digital subtraction angiography (DSA). RESULTS: Average visualization scores of CT angiography and DSA were 1.7 and 2.5, respectively, in common hepatic artery (CHA) and proper hepatic artery (PHA), 2.5 and 2.3 in right hepatic artery (RHA), 2.6 and 2.6 in left hepatic artery (LHA), 2.3 and 2.2 in segmental RHA, and 2.1 and 2.0 in segmental LHA. Stenoses were found in proximal hepatic arteries in 9 on CT angiography and 13 on DSA. Stenoses were found in branches of the hepatic artery in 21 on CT angiography and 16 on DSA. CONCLUSION: The authors' results indicate that multislice CT angiography of the hepatic arteries is equivalent to DSA and may demonstrate vascular complications of hepatic arterial infusion chemotherapy.