Endoscopic ultrasonographic abnormalities and lower esophageal sphincter function in reflux esophagitis

Endoscopic ultrasonography of the lower esophagus was performed in 25 patients with reflux esophagitis and 13 age-matched controls. Thickening of the esophageal wall and abnormalities of its architecture were detected. As these morphological changes became more extensive, the lower esophageal sphincter pressure and the decrease of sphincter pressure on relaxation were both progressively reduced. There was a significant correlation between morphological abnormalities and lower esophageal function. Our results suggest that inflammatory damage to the muscle layer of the lower esophagus may impair lower esophageal sphincter function further, especially in patients with advanced esophagitis.     

Neurinoma of the oculomotor nerve--case report.

Only 10 cases of oculomotor nerve neurinoma have been reported previously. The authors report the rarity of a neurinoma originating from Schwann cells of the oculomotor nerve. The diagnosis was based on the initial sign of oculomotor nerve paresis without involvement of other cranial nerves, neuroradiological and surgical findings, and histological features of the specimen obtained at surgery.     

Proteolytic activation of hemolysis and fusion by influenza C virus

Summary Influenza C virus has been found to cause pH-dependent hemolysis and fusion of chicken erythrocytes. For these activities, treatment of the virus with proteolytic enzymes, e.g., trypsin and elastase which were known to cause cleavage of gp88 was specifically required.With 1 Figure     

Choroid plexus arteriovenous malformations.

Among 24 arteriovenous malformations (AVMs) involving the choroid plexus, 11 were plexal type AVMs predominantly located in the choroid plexus of the lateral ventricle, and 13 were parenchymal type AVMs mainly situated in the paraventricular cerebral parenchyma. 83% of all AVMs involved both the choroid plexus and the paraventricular cerebral parenchyma. Most cases presented with intracranial hemorrhage, particularly intraventricular hemorrhage. The most serious surgical problem was a small residual nidus unrecognized at the initial operation causing postoperative hemorrhage. Five parenchymal type AVMs presented residual niduses in the choroid plexus, causing death in two cases. Two plexal type AVMs resulted in residual AVMs supplied by the cisternal segment of the anterior choroidal artery, situated in the medial temporal lobe. To prevent postoperative hemorrhage from a small residual nidus, immediate postoperative angiography while the patient is still under general anesthesia should be performed to identify any residual nidus.     

The neurological outcome in patients with acute cervical spinal cord injury]

Twenty-three patients (twenty males and three females) with acute cervical spinal cord injury were cared for within a defined protocol and followed for 14 to 589 days (mean. 133 days). We evaluated the relationship between neurological recovery and neurological examination, myelography (MLG), CT-myelography (CTM) on admission. All of them were admitted to Kitasato University Hospital within 24 hours after injury. Thirteen of the 23 patients had complete injury, and the others had incomplete injury. Result: Four factors were found to be related to neurological recovery. They included: 1) complete injury; 2) areflexia; 3) cord swelling on CTM; and 4) complete block on MLG. Fourteen of 15 patients who had at most two of the four factors improved. But, no patients with three or four factors improved. Conclusion: These four factors have been recognized as indicators of bad neurological outcome. However, our result indicates that by our result, improvement of neurological function can be expected in patients affected by only one or two of these four factors. In other words these four factors have prognostic value for predicting the neurological outcome after acute cervical spinal cord injury.     

Bilateral traumatic abducens nerve palsy without skull fracture or intracranial hematoma-a report of 3 cases and consideration of the mechanism of injury (author's transl)]

Three cases of bilateral traumatic abducens nerve palsy were presented and the mechanism of damage to the abducens nerve was discussed in relation to the analysis of traumatic force at the time of impact and topographical anatomy of the abducens nerve in detail. Case 1. A 70 year old man sustained a traffic accident with one hour loss of consciousness. Physical examination revealed a contused area on the medial side of his right forehead. Neurological examination revealed bilateral abducens nerve palsy (Fig. 1). There were no ther cranial nerve abnormalities. Roentgenograms of the skull, including views of the base and orbit showed no fracture. At follow up examination 12 months later, bilateral Duane's retraction syndrome could be noticed with slight increase in size of the pupil on each side of lateral gaze (Fig. 2). Case 2. A 32 year old women sustained a traffic accident with 31 days of loss of consciousness. At the time of admission, bilateral abducens nerve palsy and slight left hemiparesis were noticed in semicomatose condition. Right carotid angiogtam showed no evidence of intracranial hematoma. One month later, the right eye began to abduct and 2 months later, the left eye began to abduct. Three months after the injury, bilateral abducens nerve palsy could no longer be demonstrated. No retraction syndrome was observed during this period. Case 3. A 3 year old boy sustained a traffic accident with 32 days of loss of consciousness. At the time of admission, neurological examination showed bilateral abducens palsy and left sided decerebrate posture in comatose condition. At the time of discharge 3 months after admission, bilateral abducens palsy, right hemiataxia, left spastic hemiparesis and scanning speach were noticed. Three months later, right eye began to abduct and 4 months later, the left eye began to abduct. At follow up examination 6 months later, there was no evidence of abducens nerve palsy. Topographical details of anatomy of the abducens nerve are shown in Fig. 3, 4. It is greatly speculated that both abducens nerves are streched by the lineal accerelated force on mid sagittal plane at the time of impact, then the apex of petrous pyramid acts as the fulculum, so that the abducens nerves are compressed, contused and streched at this point (Fig. 5-a). The authors pointed out that the abducens nerve are impossible to be damaged at the petroclinoid ligament (Grüber's lig.) by the upward movement of the brainstem, because the abducens nerve is fixed downward below this ligament by the dura and apex of the petrous pyramid (Fig. 4-b, c). One case showed bilateral acquired retraction syndrome with slight increase in size of the pupil on each side of lateral gaze, the fact greatly suggesting that the sympathetic nerve have intimate relationship to the miss direction during the recovery stage of abducens nerve palsy.     

Progression of severe atherosclerosis and increased arterial pulse pressure in the newly developed heritable mixed hyperlipidaemic rabbits

We have recently segregated a new line of rabbit, named TGH, with severely high levels of plasma triglyceride and cholesterol. The aim of the present study was to investigate the progression of atherosclerosis and haemodynamic parameters in TGH rabbits. 2. Japanese white (JW) and TGH rabbits (24-27 months old) were anaesthetized with ketamine and xylazine. Plasma concentrations of triglyceride were 63.1 8.0 and 446.0 35.2 mg/dL in JW and TGH rabbits, respectively. Blood pressure was measured by a catheter implanted in the femoral artery. Histological examinations were performed using haematoxylin-eosin and elastica-Masson trichrome staining to detect atherosclerotic lesions. 3. The JW rabbits had no atherosclerotic lesions. In TGH rabbits, severe atherosclerotic lesions were observed throughout the aorta, especially in the aortic arch. Basal femoral arterial pressure was not significantly different between JW and TGH rabbits. However, the basal pulse pressure in TGH rabbits (48.3 4.5 mmHg) was significantly greater than that of JW rabbits (28.0 5.6 mmHg). Intravenous infusion of N(G)-nitro-L-arginine methyl ester (L-NAME; 26.9 mg/kg) increased the blood pressure of TGH and JW rabbits. There was no significant difference in the response to L-NAME between the two rabbit strains. 4. The present study shows that severe atherosclerotic changes develop in TGH rabbits and suggests that the hyperlipidaemia combined with hypercholesterolaemia and hypertriglyceridaemia is an important factor for promoting atherosclerosis in TGH rabbits. The greater pulse pressure in TGH rabbits may be due to the increased vascular stiffness with atherosclerosis. 5. This newly developed TGH rabbit line of heritable hypertriglyceridaemia with hypercholesterolaemia will become a useful animal model for studies on the role of hyperlipidaemia in the progression of atherosclerosis and in many atherosclerosis-related diseases.     

Indication of posterior lumbar interbody fusion for lumbar disc herniation

OBJECTIVE: To examine whether lumbar disc herniation with massive extrusion and/or segmental instability can be an indicator for spinal fusion or not, by comparing the outcome of posterior lumbar interbody fusion (PLIF) and discectomy alone. METHODS: One hundred seventy-four patients with PLIF and 177 patients with discectomy were retrospectively analyzed. We hypothesized two criteria for fusion: massive herniation and segmental instability. The patients were divided into four groups according to our original criteria: group F-F (n = 96) consisted of the patients who fulfilled the criteria for fusion and underwent PLIF; group nF-F (n = 78) consisted of those who did not fulfill the criteria but had PLIF; group F-nF (n = 30) consisted of those who fulfilled the criteria but underwent discectomy; group nF-nF (n = 147) comprised those who did not fulfill the criteria and underwent discectomy. Each patient was evaluated clinically and radiologically at 5 years after operation. RESULTS: Groups F-F and nF-F had significantly superior results on low back pain compared with group F-nF (F-F vs F-nF, P < 0.05; nF-F vs F-nF, P < 0.01). The frequency of additional operation at the involved level was significantly higher in group F-nF (10.0%) than in group F-F (2.0%) (P < 0.05). Postoperative instability of the adjacent segment developed in 15 cases (8.6%) in groups F-F and nF-F and in 3 cases (1.7%) in groups F-nF and nF-nF (P < 0.01). CONCLUSION: Lumbar disc herniation with massive herniation or segmental instability can be well treated with PLIF.