A New Instrument for Immobilization and Hemostasis During Minimally Invasive Direct Coronary Artery Bypass ("MIDCAB doughnut"): Experimental Study

A bstract A new instrument for the immobilization and hemostasis of an anastomotic site is described for use during minimally invasive off-pump direct coronary artery bypass (MID-CAB). The mechanism is based on air suction of the heart surface. The instrument is unique in that it can avoid direct temporary of the distal end of the coronary artery to control bleeding. With this instrument, anastomosis of left intemal thoracic artery to left anterior descending artery (LAD) was successfully performed on three pigs. Additionally, in six patients the LAD could be stably and securely immobilized in the beating heart by the present instrument. The instrument is hereinafter referred as "MIDCAB doughnut," which can make an operative field motionless and bloodless without distal snaring.     

Differential anatomical and cellular patterns of connexin43 expression during postnatal development of rat brain.

We have shown previously that connexin43 in the adult rat central nervous system (CNS) is predominantly localized at astrocytic gap junctions. Here we document immunohistochemically the emergence of connexin43-immunoreactive (connexin43-IR) structures and the regional patterns of connexin43 expression during postnatal maturation of the rat brain. On Western blots, connexin43 was detected in brain samples at postnatal day (P) 5, the earliest age studied. Immunohistochemically, most brain regions displayed a characteristic sequence of transient immunoreactive profiles that ultimately gave rise to the uneven distribution of the protein seen in adults. Generally, brains at P1-P5 exhibited long, fibrous connexin43-IR elements which were identified as radial glial cells. This fibrous immunostaining was considerably diminished at P5 and was replaced by short immunoreactive processes which predominated up to P10. These processes had a stellate appearance, emanated from partially stained astrocytic cell bodies and were heterogeneously distributed throughout the developing brain. By P15, there occurred only punctate immunolabelling similar to that seen in adult brain. Some brain regions including the amygdaloid complex, septohypothalamic nucleus, preoptic hypothalamus, zona incerta, ependyma and subfornical organ were exceptional in that they displayed adult immunostaining patterns at early postnatal ages suggesting a precocious maturation of gap junctions in these areas. We conclude that the highly heterogeneous distribution of connexin43-immunoreactivity among defined nuclear structures in adult brain does not reflect an antecedent requirement for connexin43 in early brain morphogenesis, but rather is related to the development of neuronal activity, the establishment of functional circuitry and the contribution of astrocytic gap junctions to glial metabolic coupling and potassium spatial buffering in the mature CNS.     

A one-year series of pediatric emergency department wheezing visits: the Hawaii EMS-C project.

During a 12-month period ending on November 30, 1988, data were collected on 2468 pediatric patients with wheezing who visited a pediatric ED. Cohort characteristics included: sex (64% male, 36% female), history of prematurity (12%), evidence of concurrent infection (82%), taking theophylline (35%), taking beta adrenergics (60%), taking cromolyn (6%), and taking corticosteroids (4%). The hospitalization rate was 10.5%. Seasonal variations, weather, air quality, and infections appeared to have significant effects on the daily variation of wheezing exacerbations. Initial oxygen saturation (OSAT) correlated with disease severity as measured by hospitalization risk and the number of bronchodilator treatments required in the ED. A suggestion for categorizing the treatment of asthma based on past history is proposed. Using this system in conjunction with pulse oximetry, wheezing severity and appropriate therapy can be more objectively determined.     

Evaluation of the measurement of plasma fructosamine concentration in aged subjects

Recently, plasma fructosamine concentration has been used as an indication of mean plasma glucose level preceding at last 1 to 2 weeks. In the present study, to characterize the clinical significance and problems of plasma fructosamine concentration in aged subjects (greater than or equal to 65 yrs), we determined plasma fructosamine concentration as well as serum albumin, total protein, HbA1, AbA1c and fasting plasma glucose concentrations in 81 (less than 65 yrs) non-diabetic subjects (group A), 161 aged (greater than or equal to 65 yrs) non-diabetic subjects and 26 aged diabetics (group D). Aged non-diabetic subjects were further classified into 75 subjects with good ADL (group B) and 86 with poor ADL (group C). The normal limit of plasma fructosamine concentration (mean +/- 2SD) in group A was 24% higher (3.1 mmol/l) than that in group B (2.5 mmol/l) but the plasma fructosamine/serum albumin ratio (F/ALB) was similar in these two groups. Plasma fructosamine correlated negatively (p less than 0.01) with age. This aging effect was explained by the reduced serum albumin in aged subjects. However, in group C, reduced plasma albumin was not associated with reduced plasma fructosamine. Plasma fructosamine corrected by albumin (F/ALB) is a useful parameter of blood glucose control in aged subjects. In aged subjects with poor ADL, HbA1, HbA1c and plasma glucose should be determined with fructosamine.     

Clinicopathologic Study of Angiogenesis in Japanese Patients with Breast Cancer

p = 0.0007) and tumor necrosis (TN) (HMC: p = 0.0050). Univariate analysis showed that AMC or HMC was a statistically significant predictor of overall survival in all patients ( p = 0.0086 and p = 0.0307, respectively). Multivariate analysis showed that AMC was an independent predictor of node status when we fitted a model with node status, BVI, and either AMC or HMC; but HMC was not independent. However, when we fitted a model including all 11 of the other indicators and AMC or HMC, the node status, HG, and LI were independent predictors, but AMC and HMC were not. Although AMC was a better method than HMC for evaluating angiogenesis, we cannot confirm angiogenesis as a significant independent prognostic factor associated with long-term survival in Japanese breast cancer patients.     

Radiological evaluation on allograft reconstruction of the acetabulum combined with supporting device in revision total hip replacement.

We reviewed the radiographs of 25 hips of 20 patients who had received revisions of the acetabular components of total hip replacement supplemented by allograft for bone defects. Bone defects in 20 hips (80%) were classified into type D (cranio-central defect) according to Itoman's classification. In eight, sockets were installed directly on the allografts (group A). A metallic supporting device was used for reinforcing the grafts in 17 hips (group B). The position of the acetabular socket was measured on a radiograph, taken immediately after revision surgery and again at the latest follow-up. Using a MEM template, cranial and central migrations were determined. Mean cranial migration in hips of group A was 3.6 mm. Group B was 0.2 mm. Maintenance of thickness of the allografts was 60.6% in the cranial region and 75% in the central in group A. In the hips of group B, however, almost 100% of the initial thickness was maintained cranially and centrally. Allograft reconstruction of acetabular bone defect in revision total hip replacement is a beneficial procedure. The remaining pelvic bone is usually in poor condition, therefore, it is necessary to ensure primary fixation by the metallic supporting device.     

A case of ''low tension glaucoma'' with primary empty sella.

A case of 'low tension glaucoma' with primary empty sella is reported. The visual field defect and optic disc change were characteristic of glaucoma. The intraocular pressure was within normal limits. X-ray examination and the metrizamide-CF procedures revealed a primary empty sella. The coexistence of 'low tension glaucoma' and empty sella is discussed.