Inferior temporal sulcus approach for amygdalohippocampectomy guided by a laser beam of stereotactic navigator

OBJECTIVE: To describe a surgical technique for a minimally invasive transcortical transventricular amygdalohippocampectomy via the inferior temporal sulcus (ITS) using a stereotactic navigator. METHODS: Seven patients with medically intractable mesial temporal lobe epilepsy underwent an amygdalohippocampectomy via the ITS. By use of a laser-guided navigation system, the epileptogenic foci of the mesial temporal lobe were resected through a small linear operative route that was made by a brain speculum inserted from the ITS to the anterolateral floor of the temporal horn in the lateral ventricle. RESULTS: All patients completed at least a 1-year follow-up (range, 14-45 mo) after surgery and had improved neuropsychological parameters as a result of the operation. All patients became seizure-free after surgery. A Humphrey visual field perimeter detected no hemianopsia. CONCLUSION: Combined with the stereotactic navigation system, the ITS approach provides the least invasive amygdalohippocampectomy that preserves optic radiation. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.     

Implications of fibrinogenolysis in patients with closed head injury

The objective of this study was to determine the clinical significance of fibrinogenolysis in patients with isolated closed head injury. We correlated indices of fibrinolytic activity, fibrinogen degradation products (FgDP), and fibrin degradation products (FbDP) with outcome in order to accomplish this. This study consisted of 40 patients with isolated closed head trauma in whom blood sampling could be initiated within 3 h after injury. Patients were divided into two groups according to Glasgow Outcome Scale status at 3 months after injury, characterized as good recovery or moderate disability (group 1, n = 21); and severe disability, vegetative, or death (group 2, n = 19). The plasma fibrinogen concentration correlated with the Glasgow Coma Scale score on admission (r2 = 0.201, p < 0.01), and plasma fibrinogen concentrations in group 2 were lower than in group 1 (p < 0.05). Plasma concentrations of fibrin/fibrinogen degradation products (FDP) and plasmin-alpha2-plasmin inhibitor complex (PIC), molecular markers of activation of fibrinolysis, were higher in group 2 than in group 1 (p < 0.001), and both FgDP and FbDP concentrations in group 2 also were higher than in group 1 (p < 0.001). Both the FgDP and FbDP concentrations correlated with the PIC concentration. Moreover, the plasma FgDP concentrations correlated inversely with alpha2-plasmin inhibitor activity, a potent inhibitor of the fibrinolytic sysytem, as did the FbDP concentration. This study reveals that both fibrinolysis and fibrinogenolysis are involved in the coagulopathy that develops during the acute phase of head injury and correlate with fibrinolytic activity. Decreased activity of alpha2-plasmin inhibitor may contribute to fibrinogenolysis.     

Molecular factors promoting carcinogenesis and malignant behavior of intraductal papillary mucinous tumors

Many molecular factors related to the carcinogenesis and malignant behavior of pancreatic cancer were identified by investigation of intraductal papillary mucinous tumors (IPMTs). Molecules controlling the G1/S phase, such as p53, p21, p61, and cyclin D1, tumor suppressors including DPC-4, and many other factors such as MUC-1/2 contribute to the promotion of the malignant behavior of IPMTs. They will be important molecular targets for the radical treatment of pancreatic cancer.     

Renoprotective effect of triple therapy with low-dose angiotensin receptor blocker,low-dose diuretic and Ca-antagonist in hypertensive type 2 diabetic patients with overt nephropathy

Combination therapy with angiotensin receptor antagonist(ARB) plus angiotensin converting enzyme inhibitor(ACE-I) (ARB/ACE-I) was efficacious in reducing proteinuria in patients with progressive renal disease. However, this therapy may be associated with the worsening of anemia and hyperkalemia. The present study addressed whether or not triple therapy with low-dose ARB, low-dose diuretic (D) and calcium channel blocker(CCB) (ARB/D/CCB) is as effective as therapy with low-dose ARB/ACE-I in retarding the progression of overt diabetic nephropathy. In the triple therapy, the patients were initially subjected to monotherapy with CCB for 24 weeks. Low-dose ARB and low-dose D were added to the treatment for an additional 24-week period. In parallel, patients undergoing double therapy were initially treated with low-dose ACE-I alone for 24 weeks, and then low-dose ARB was added for an additional 24-week period. The results were as follows: 1) In the triple therapy, blood pressure was reduced by 9 mmHg in systole and 5 mmHg in diastole (not significant) compared to monotherapy with CCB. There was a significant decline in proteinuria (3.3 +/- 1.2 g/day in the CCB-treated period vs. 2.1 +/- 1.0 g/day in the ARB/D/CCB-treated period, n = 12, p = 0.0143). Furthermore, a significant improvement in the slope of reciprocal serum creatinine concentration(1/Cr) was found in response to triple therapy(1/Cr: -0.0118 +/- 0.0009 in the CCB-treated vs. -0.0035 +/- 0.0028(I/mg/dl/month) in the ARB/D/CCB-treated period, n = 12, p < 0.001). There was neither a worsening of anemia nor an increase in the serum potassium(K) concentration. 2) In the double therapy, blood pressure was reduced by 12 mmHg in systole(p = 0.0079, n = 11) and 6 mmHg in diastole(n = 11, p = 0.0037) compared to the monotherapy with ACE-I. A significant improvement in the slope of 1/Cr was found in the double therapy(1/Cr: -0.0095 +/- 0.0052 in the ACE-I treated period vs. -0.0029 +/- 0.0028(I/mg/dl/month) in the ARB/ACE-I, n = 11, p < 0.001). In addition, there was a substantial reduction in hematocrit and increase in serum K concentration. The present result suggests that triple therapy consisting of ARB/D/CCB is as efficacious as double therapy with ARB/ACE-I in protecting the kidney from the progression in patients with diabetic overt nephropathy. The former may be expected to have less adverse effects.     

Recurrent meningitis associated with complete Currarino triad in an adult--case report

A 58-year-old woman presented with Currarino triad manifesting as recurrent meningitis. Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality, and an anorectal malformation, which is caused by dorsal-ventral patterning defects during embryonic development. She had a history of treatment for anal stenosis in her childhood. Radiographic examinations demonstrated the characteristic findings of Currarino triad and a complicated mass lesion. The diagnosis was recurrent meningitis related to the anterior sacral meningocele. Neck ligation of the meningocele was performed via a posterior transsacral approach after treatment with antibiotics. At surgery, an epidermoid cyst was observed inside the meningocele. The cyst content was aspirated. She suffered no further episodes of meningitis. The meningitis was probably part of the clinical course of Currarino triad. Radiography of the sacrum and magnetic resonance imaging are recommended for patients with meningitis of unknown origin. The early diagnosis and treatment of this condition are important.     

Oncological effects of insufflation with different gases and a gasless procedure in rats

Background: The validity of using carbon dioxide (CO₂) pneumoperitoneum in laparoscopic tumor surgery has not been investigated thoroughly. The oncologic effects of a gasless procedure and insufflation with different gases were compared in rats. Methods: In all the experiments, Donryu rats were randomized to receive a gasless procedure; to receive insufflation with CO₂, helium, or air at 10 mmHg for 30 min, or to serve as control subjects without insufflation. In experiment 1, involving 60 rats, ascites hepatoma AH130 cells were inoculated intraperitoneally just before the procedures. The S-phase fraction of the intraperitoneal tumor cells was determined using a flow cytometry on day 7. In experiment 2, 60 rats injected intraperitoneally with latex particles received one of the procedures. At the end of the procedure, peritoneal macrophages were harvested to determine the number of phagocytosed particles. In experiment 3, 75 rats inoculated intraperitoneally with AH130 cells received one of the procedures for 5 consecutive days and were followed for survival analysis. Results: Experiment 1: The S-phase fraction was lower after insufflation with air or helium (p < 0.01) than with the anesthesia control condition. Insufflation with CO₂ showed a higher S-phase fraction than the gasless procedure or insufflation with air or helium ( p < 0.01). Experiment 2: The phagocytotic activity of peritoneal macrophages was increased by insufflation with helium and air, as compared with the control condition ( p < 0.01). Insufflation with CO₂ deteriorated the phagocytotic activity more than the gasless procedure ( p < 0.05) or insufflation with air or helium ( p < 0.001). Experiment 3: Insufflation with gases demonstrated shorter survival than the anesthesia control condition or the gasless procedure regardless of the gases used (p < 0.01). Conclusions: These results suggest that the choice of gases may affect the proliferation of tumor cells and the phagocytotic activity of peritoneal macrophages, insufflation itself may promote tumor spread regardless of the gases used, and the gasless procedure may be oncologically advantageous in this animal model.     

Study of active substances involved in skin dysfunction induced by crowding stress. I. Effect of crowding and isolation on some physiological variables,skin function and skin blood perfusion in hairless mice

The effects of five levels of population density on various organs, the neuroendocrine system, skin function, skin blood perfusion, and blood parameters were studied in the hairless mouse. Skin barrier recovery was evaluated by measuring transepidermal water loss after tape stripping. Blood perfusion was measured by means of a laser Doppler imaging technique. The effect of a parasympathetic nerve stimulator, carpronium chloride, on skin function in the crowded animal model was also examined. A 7 d crowding (10, 15, 20 mice/cage) significantly increased the levels of corticosterone, catecholamines (norepinephrine, epinephrine and dopamine), glucose and serum lactate dehydrogenase activity in circulating blood, induced atrophy of kidney, ovary and thymus and hypertrophy of adrenal glands, and decreased body weight gain in comparison with the control (5 mice/cage). Crowding also increased epidermal thickness and epidermal proliferative activity, and decreased corneocyte size, rate of barrier recovery and skin blood perfusion. Most of these changes became more marked with increasing population density and/or longer exposure to a crowded environment. Isolation (1 mouse/cage) increased the level of norepinephrine and rate of skin blood perfusion, and significantly delayed barrier recovery. Repeated topical applications of carpronium chloride for 7 d improved the changes in skin blood perfusion, barrier recovery, kidney and ovary, and epidermal morphology induced by crowding. The crowded animal model could be useful for quantifying objectively the influence of crowded environment-induced stress on cutaneous function and blood perfusion.     

Biological activity of tropolone

Tropolone (1). showed strong insecticidal activity on Tyrophagus putrescentiae and Dermatophagoides farinae. The insecticidal effect of 1 on both insects was stronger than that of hinokitiol (2, 4-isopropyltropolone: major component of Thujopsis dolabrata SIEB. et ZUCC. hondai MAKINO). The insecticidal activity of both compounds was higher than that of N,N-diethyl-m-toluamide (DEET), used as a positive control. Compound 1 had potent insecticidal activity against Coptotermes formosanus, although its activity was much lower than that of commercial chloropyrifos. Like 2, 1 showed the inhibitory activity toward metalloproteases such as carboxypeptidase A, collagenase and thermolysin and their inhibitory activities were much higher than that of 1,10-phenanthroline, used as a positive control. The inhibitory activity of 1 on carboxypeptidase A was especially high, its 50% inhibitory concentrations (IC(50)) being 2.73 x 10(-6) M. This inhibitory activity was as high as that of 2 (IC(50): 2.76 x 10(-6) M). Compound 1 inhibited the growth of seven kinds of plant-pathogenic fungi and their minimum inhibitory concentration (MIC) values were in the range of 6.0-50.0 microg/ml. In particular, 1 showed strong antifungal activity on Pythium aphanidermatum IFO-32440 (MIC: 6.0 microg/ml).     

Mechanical hypersensitivity and alterations in cutaneous nerve fibers in a mouse model of skin cancer pain

Melanoma inoculation induced marked mechanical allodynia and hyperalgesia in the periphery of the melanoma mass in mice from about day 10 post-inoculation. In the middle of the tumor, there were slight hyperalgesia and response disappearance in the early and late phases, respectively. PGP9.5-like immunoreactivities increased in the epidermis of the periphery of the tumor and disappeared from the dermis of the middle on day 18 post-inoculation, without apparent alterations on day 10. When using this pain model, one should consider the tumor site-dependent responses.