Orbital development after enucleation without orbital implant in early childhood]

PURPOSE: To evaluate the development of orbital volume in five adults who underwent enucleation without orbital implant during early childhood, using reconstructed computed tomography(CT) images. MATERIALS AND METHODS: The orbital volume of 5 adults who underwent enucleation without orbital implants during early childhood was measured using CT images, and the results were compared between the anophthalmic orbit and the unaffected orbit in each case. The shape of maldevelopmental orbit and the relationship between orbital development and replacement of the prosthesis were also investigated. RESULTS: Orbital development in patients who underwent enucleation without orbital implant during early childhood was delayed in comparison with the unaffected orbit, and the delayed development was especially remarkable at the part of orbit corresponding to the equator of the eyeball. Maldevelopment of the orbit was severer in cases without replacement of the prosthesis than with it. CONCLUSION: For the development of orbital volume in anophthalmos after enucleation, orbital volume in place of the eyeball is required. Therefore, orbital implantation at the time of enucleation and replacement of the prosthesis with larger ones as the body grows are important.     

Expression of parathyroid hormone/parathyroid hormone-related peptide receptor 1 in normal and diseased bladder detrusor muscles: a clinico-pathological study

Background

To investigate the expression of parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor 1 (PTH1R) in clinical specimens of normal and diseased bladders. PTHrP is a unique stretch-induced endogenous detrusor relaxant that functions via PTH1R. We hypothesized that suppression of this axis could be involved in the pathogenesis of bladder disease.

Methods

PTH1R expression in clinical samples was examined by immunohistochemistry. Normal kidney tissue from a patient with renal cancer and bladder specimens from patients undergoing ureteral reimplantation for vesicoureteral reflux or partial cystectomy for urachal cyst were examined as normal control organs. These were compared with 13 diseased bladder specimens from patients undergoing bladder augmentation. The augmentation patients ranged from 8 to 31 years old (median 15 years), including 9 males and 4 females. Seven patients had spinal disorders, 3 had posterior urethral valves and 3 non-neurogenic neurogenic bladders (Hinman syndrome).

Results

Renal tubules, detrusor muscle and blood vessels in normal control bladders stained positive for PTH1R. According to preoperative urodynamic studies of augmentation patients, the median percent bladder capacity compared with the age-standard was 43.6% (range 1.5–86.6%), median intravesical pressure at maximal capacity was 30 cmH₂O (range 10–107 cmH₂O), and median compliance was 3.93 ml/cmH₂O (range 0.05–30.3 ml/cmH₂O). Detrusor overactivity was observed in five cases (38.5%). All augmented bladders showed negative stainings in PTH1R expression in the detrusor tissue, but positive staining of blood vessels in majority of the cases.

Conclusions

Downregulation of PTH1R may be involved in the pathogenesis of human end-stage bladder disease requiring augmentation.     

Diagnosis of the depth of invasion of gallbladder carcinoma by EUS.

BACKGROUND: The prognosis of gallbladder carcinoma is dismal and relates to the depth of invasion as expressed by the T factor in TNM staging. We evaluated the utility of endoscopic ultrasound (EUS) in the diagnosis of the depth of invasion of gallbladder cancer. METHODS: Thirty-nine patients who underwent both EUS and surgery were included in this study. The EUS images were classified according to the relation between tumor echo pattern and gallbladder-wall structure, and the resulting types were compared with depth of invasion as determined histologically. Based on the results, a set of diagnostic criteria is proposed. RESULTS: The EUS images were classified into four categories. Type A is a pedunculated mass with a fine-nodular surface and intact neighboring wall. Type B is a broad-based mass with an irregular surface and intact outer hyperechoic layer of the adjacent wall. In type C, the outer hyperechoic layer is irregular due to a mass echo, whereas, in type D, the outer hyperechoic layer is disrupted by a mass echo. Each of the four categories of EUS images correlated well with the histologic depth of invasion. CONCLUSION: EUS is useful in the T staging of gallbladder cancer.     

Activation of brain mechanisms of attention switching as a function of auditory frequency change.

The activation of the cerebral network underlying involuntary attention switching was studied as a function of the magnitude of auditory change. Event-related brain potentials (ERPs) were recorded during the performance of a visual discrimination task in which task-irrelevant auditory frequency changes of six different levels (5%, 10%, 15%, 20%, 40% and 80%) occurred randomly within the same stimulus sequence. All the frequency changes elicited a typical ERP waveform, characterized by MMN, P3a and RON, their respective amplitudes increasing linearly as a function of the magnitude of change. The results indicate that attentional processes in the brain may follow a linear function of activation, contrasting with the well-established logarithmic functions underlying perceptual and psychophysical processes.