Early fetal development of hard tissue pulleys for the human superior oblique and tensor veli palatini muscles

The trochlea for the superior oblique muscle as well as the hamulus for the tensor veli palatini muscle is well known as a fibrocartilage-associated, hard tissue pulley that changes the direction of the tendon. However, details of the fetal development of these structures remain obscure. We carried out a histological study of hematoxylin-eosin-stained preparations from 20 human fetuses (7-15 weeks of gestation) and clarified a common rule for the formation of these pulleys: changing in the location of a structure for the muscle insertion. At the early stage, the muscle and insertion exhibit an almost straight course alongside the primitive pulley, but because the structure for insertion later moves away from a straight line along which the muscle acts, the tendon begins to turn around the cartilage by 12 weeks. The posterior shift of the soft palate is clearly evident, but rotation of the sclera or eyeball is difficult to identify in sections. To some degree, the trochlea may originate from a common anlage with the sclera. We hypothesize that, from the evolutionary point of view, the hamulus or trochlea do not form for the pulley itself but as a structure independent of the related muscle function. The fetal topographical anatomy around the tensor veli palatini, as well as its relationship to the tensor tympani, is also described.     

Left temporal perfusion associated with suspiciousness score on the Brief Psychiatric Rating Scale in schizophrenia

We evaluated the relationship between regional cerebral blood flow (rCBF) and clinical symptoms in patients with schizophrenia. Single photon emission computed tomography with N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) was used to study 29 patients with schizophrenia. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). We examined the correlation between rCBF and each BPRS item score using Statistical Parametric Mapping software. Corrected P-values < 0.05 were considered as statistically significant. The suspiciousness score on the BPRS was positively correlated with rCBF in the left inferior temporal gyrus. There was no significant correlation between rCBF and any other items of the BPRS. There was no significant correlation between rCBF and chlorpromazine-equivalent dosage. This analysis permits the quantitative assessment of the severity of persecutory delusions in relation to left temporal perfusion in patients with schizophrenia.     

Granulomatous amoebic encephalitis caused by balamuthia mandrillaris

A 51-year-old immunocompetent Japanese woman presented with a rare case of granulomatous amoebic encephalitis (GAE) caused by Balamuthia mandrillaris. She was brought to our hospital with epilepsy. Magnetic resonance imaging of the brain revealed a homogeneously enhanced solitary mass in the left frontal lobe. Histological diagnosis was made by a biopsy, which suggested lymphomatoid granulomatosis. After that, her neurological condition got worse. New masses were found and had spread across the whole brain. She died 2 months later of cerebral hernia. Autopsy revealed that the patient had GAE caused by Balamuthia mandrillaris. GAE is usually fatal, and is difficult to diagnose except at autopsy. Therefore, awareness of this disease is important, and earlier diagnosis and the development of a better therapeutic strategy will improve clinical outcome.     

Function of the transplanted canine heart after prolonged preservation by simple immersion

Summary The purpose of this study was to investigate the maximum limits of a simple topical cooling method with preservation of graft viability following orthotopic transplantation. Coronary vascular washout was performed with cold potassium-verapamil cardioplegia. The heart was then removed, suspended in the same solution, and stored at 4°C. The experimental material was divided into three groups according to the preservation time: 24 h in group I (six animals), 36 h in group II (five animals), and 48 h in group III (three animals). All six animals in group I and four of five animals in group II maintained a stable recipient circulation after transplantation. No animals in group III could be taken off cardiopulmonary bypass. Contraction band injury after transplantation was more frequently observed in the group II grafts than in those of group I. In conclusion, the combination of coronary vascular washout with cold potassium-verapamil cardioplegia and storage at 4°C in the same solution may preserve the canine heart for 24–36 h, as demonstrated by cardiac function immediately after orthotopic transplantation.     

Orthotopic transplantation of the canine heart after prolonged preservation by simple immersion

The viability of the heart was assessed following orthotopic transplantation. Following coronary vascular washout with cold potassium-verapamil cardioplegia, the heart was removed, immersed in the same solution, and stored at 4°C for 24 hours in Group I (6 animals), 36 hours in Group II (5 animals), and 48 hours in Group III (3 animals). All six animals in Group I and four of five animals in Group II maintained a stable recipient circulation for the acute phase of 2 hours after transplantation, without cardiopulmonary bypass. For the dogs in Group III, cardiopulmonary bypass was vital. Contraction band injury after transplantation was more frequently observed in the Group II grafts than those of Group I. We conclude that the combination of coronary vascular washout with cold potassium-verapamil cardioplegia and storage at 4°C in the same solution may preserve the canine heart for up to 24 to 36 hours, as demonstrated by post-orthotopic transplantation function. Presented at the Thirty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Kyoto, Japan, November 11–13, 1983     

Diffusion-weighted echo planar imaging of the normal human cervical spinal cord

We obtained diffusion-weighted echo planar images of the human cervical cord in vivo and correlated them with histopathologic findings. Images were obtained in 17 healthy volunteers using a 1.5 T clinical MR unit. When motion-probing gradients were added perpendicular to the long axis of the cord, the white matter was hyperintense because of anisotropic diffusion. However, the gracile fasciculus was hypointense probably due to the small diameter of neural fibers and the large extracellular space.     

Objective assessment of autophony during phonation in the diagnosis of patulous Eustachian tube patients

ObjectiveA system enabling the objective assessment of the transmission of voice sounds to the external auditory canal (EAC) during phonation has recently been revised. Our aim was to evaluate the effectiveness of this new system in the diagnosis of patulous Eustachian tube (PET) patients by comparing the results obtained using this method with those obtained from conventional objective tests to diagnose PET.MethodsA prospective survey of medical records was included with definite PET, possible PET, and sensorineural hearing loss as control. The measurement system consists of a personal computer, an AD/DA converter (NI 6361, National Instruments), a probe microphone system for recording voice sound (ER-10C, Etymotic Research) and two microphones for measuring noise sound in the EAC (ER-10B+, Etymotic Research). Pronouncing the "Ni" sound for 5 s were recorded with these three microphones. The ratio of the maximum sound pressure of voice sound and noise sound in EAC (EAC/Voice) was simultaneously calculated, and results were displayed on a personal computer for diagnosing.ResultsThirty-one patients of 42 ears with definite PET, 26 patients of 38 ears with possible PET, and 12 patients of 24 ears with sensorineural hearing loss as control were included. The EAC/Voice were 8.63 ± 5.43, 25.41 ± 32.63, and 25.87 ± 24.93 in the control, definite PET, and possible PET group respectively. The control group was significantly different from the definite PET (p < 0.05) and possible PET group (p < 0.05). ROC curve analysis confirmed 14.7 as the best diagnostic cut-off value of EAC/Voice (area under the curve=0.782, 95% CI 0.671–0.894). By adopting this cut-off point, 25 (56.8%) and 22 (61.1%) ears were determined as positive findings in the definite PET and possible PET group, respectively. There was no significant correlation between the positive findings judged by the current method and that of sonotubometry in the control (r = -0.63, p = 0.769), definite PET (r = 0.12, p = 0.451), and possible PET group (r = 0.12, p = 0.451).ConclusionThe current system is more useful in the objective assessment of autophony during phonation by calculating the ratio of voice sound and elicited noise sound transmitted in the EAC (EAC/Voice). This method seems promising because it is able to detect cases eluding conventionally used test methods such as sonotubometry performed without phonation, thereby increasing the accuracy of PET diagnoses.     

Ear injury caused by a sticky-tipped applicator

We here report a relatively rare case of traumatic injury of the tympanic membrane caused by a sticky-tipped applicator as well as some characteristics of this sticky-tipped applicator that were examined experimentally. This rare case was very unusual in that the injury was caused by external force applied from the medial to lateral direction during very careful cleaning (no unexpected force). Although removal of cerumen by a sticky substance seems to be an excellent idea, the present case shows that the stickiness that facilitates removal of the cerumen may be dangerous for thin, dry skin such as the tympanic membrane. Actually, the experimental considerations indicated that the stickiness was affected by the surface condition of the objective: soft, dry conditions increase it, while on the contrary, moist, dusty and oily conditions reduce it. The stickiness of the applicator, which was adjusted to use in the ear canal with an oily surface, appeared to be too large for a dry tympanic membrane. It is recommended that the sticky substance should be removed from the tip area or reduced by application of oil or powder before use.     

Staged operations for posthemorrhagic hydrocephalus in extremely low-birth-weight infants with preceding stoma creation after bowel perforation: surgical strategy

Case report We report a complicated extremely low-birth-weight (ELBW) infant with posthemorrhagic hydrocephalus after intraventricular hemorrhage and preceding stoma creation after bowel perforation who was treated with staged operations, including shunting and external ventricular drainage. The first operation was a temporary valveless ventriculoperitoneal (VP) shunt placement until the time of the stoma closure. The stoma was successfully closed 3 months after the first operation when the peritoneal tube was drawn out from the chest wall and the VP shunt system was temporarily used as an external drainage with a long subcutaneous tunnel. One month after the second operation, final VP shunt placement was performed after good healing of bowel anastomosis was surely confirmed. The previous peritoneal shunt tube was cut behind the ear, removed, and replaced with a valve-regulated VP shunt system. Conclusion This staged strategy is a safe and feasible option for complicated ELBW infants with preceding stoma and hydrocephalus.