Basic and clinical evaluation of the measurement of bone resonant frequency

Summary A new computerized apparatus was constructed to measure the resonant frequency of human ulnain vivo with high sensitivity and reproducibility. Experimental studies using aluminum bar and dried human bone revealed the importance of the ulna being positioned parallel to the radius, approximately 90 degree flexion of the elbow joint, and minimal muscle activity in order to demonstrate maximum resonant frequency of ulna. Measurement of bone resonance in monkeysin vivo and after removal of the bonein vitro showed good agreement. Product of F (maximum resonant frequency in Hz) and L (ulnar length in cm), FL, indicating the speed of propagation of sound wave through the ulna, showed a significant positive correlation with bone mineral content/bone width (BM/BW) measured by Norland-Cameron apparatus and age-bound decline in both sexes. Patients with osteomalacia and primary hyperparathyroid bone disease tended to have higher FL values than expected from BM/BW. Two-dimensional display of FL and BM/BW thus appears to be useful in distinguishing osteoporosis from osteomalacia better than the use of BM/BW alone.     

Effects of fexofenadine hydrochloride in a guinea pig model of antigen-induced rhinitis

Allergic rhinitis is an inflammatory disease of the nasal mucosa, induced by histamine, leukotrienes, and other substances released from mast cells. Fexofenadine hydrochloride, the active metabolite of terfenadine, is a novel, nonsedating antiallergic drug having H1 receptor antagonistic activity. Fexofenadine is effective for the treatment of allergic rhinitis. However, its mechanism of action in attenuating nasal congestion has not yet been elucidated. Therefore, we first examined the effects of fexofenadine on a guinea pig model of antigen-induced rhinitis. We also evaluated the effects of mepyramine, zafirlukast and ramatroban in this model; these drugs are an H1 receptor antagonist, a selective leukotriene antagonist and a selective thromboxane antagonist, respectively. Rhinitis was induced by ovalbumin (OVA) instillation into the nasal cavity of animals that had been sensitized by two earlier OVA injections (s.c. and i.p.). The nasal airway resistance was measured for 45 min after the challenge. Fexofenadine hydrochloride (20 mg/kg) and terfenadine (20 mg/kg) administered orally 70 min prior to the challenge significantly inhibited (fexofenadine, p < 0.001, terfenadine, p < 0.05) the increase in nasal airway resistance. Ramatroban (30 mg/kg) administered orally 60 min prior to the challenge also significantly inhibited (p < 0.05) the increase in nasal airway resistance. In contrast, mepyramine (3 mg/kg i.v.) and zafirlukast (3 mg/kg p.o.) failed to reduce the increase in nasal airway resistance. These results suggest that thromboxane may be involved in the increase in the nasal airway resistance in this model. Accordingly, fexofenadine may reduce the increase in nasal airway resistance by inhibiting the release of chemical mediators, including thromboxane, that are involved in the increase in nasal airway resistance in this model.     

Encephalopathy with isolated reversible splenial lesion of the corpus callosum

We report a 51-year-old Japanese man with chronic alcoholism who complained of mental confusion following respiratory and intestinal infections. The splenium of the corpus callosum showed hyperintensity on both diffusion-weighted MR images and fluid-attenuated inversion recovery images and hypointensity on T1-weighted images. These findings were resolved on MR images obtained 3 days later. He showed complete neurological recovery within 2 months. We suspected that he had mild encephalopathy with a reversible splenial lesion after systemic viral or bacterial infection.     

Placental site trophoblastic tumor of the uterine cervix occurring from undetermined antecedent pregnancy

A cervical polyp complicated by severe hemorrhage was removed from a 43-year-old Japanese woman (gravida 0), who had undergone tubectomy on the right side 10 years previously. The polyp was diagnosed by immunohistochemical studies as placental site trophoblastic tumor of the cervix, but no metastatic foci were found in any other uterine site. The tumor was further demonstrated by PCR polymorphisms to possess two genomic DNA of the patient and her husband. Serum beta-hCG and urinary hCG titers were both low, which rapidly fell to 0.8 mIU/mL after a total hysterectomy and remained 0.2 mIU/mL after dismission. She has been uneventful for 3 years.     

Effects of cariporide (HOE642) on myocardial infarct size and ventricular arrhythmias in a rat ischemia/reperfusion model: comparison with other drugs

The effects of pretreatment with cariporide on myocardial infarction and ventricular arrhythmias in a rat model of ischemia/reperfusion were compared with those of nicorandil, propranolol, and nifedipine. Each drug was administered intravenously before coronary occlusion. Cariporide at 0.1, 0.3, and 1 mg/kg significantly reduced the infarct size (infarct mass/risk mass) from 28 +/- 4% (vehicle control value) to 9 +/- 3, 9 +/- 3, and 5 +/- 2%, respectively. Propranolol at 2.5 mg/kg also significantly reduced the infarct size to 11 +/- 1%. Neither nicorandil nor nifedipine was effective when given at 0.1 mg/kg. Cariporide dose dependently decreased the number of ischemia-induced ventricular premature beats (VPB), incidence and duration of ventricular tachycardia, and the number of reperfusion-induced VPB. Nicorandil was effective against only VPB after reperfusion, and propranolol reduced only postischemic arrhythmias, but nifedipine had no effect on either type of arrhythmia. In summary, cariporide reduced the infarct size and dose dependently suppressed arrhythmias induced by ischemia/reperfusion in rats. In contrast, in the present rat model, the doses of the other three drugs used in this study did not show comparable effects.     

Three-year prospective randomized study of incidence of posterior capsule opacification in eyes treated with topical diclofenac and betamethasone

PURPOSE: To investigate the incidence of posterior capsule opacification (PCO) in eyes treated with diclofenac sodium (DFNa) and betamethasone phosphate (BMS) ophthalmic solutions. METHODS: A total of 200 eyes with silicone intraocular lens implantation were treated with topical agents for 3 months postoperatively. Twenty-six cases of the DFNa group and 34 of the BMS group met the criteria, and the severity of PCO was evaluated after 3 years. RESULTS: The results of axial densitometry by Scheimpflug photography were 27.8 computer-compatible tapes (CCT) in the DFNa-treated group and 32.6 CCT in the BMS-treated group (p = 0.1539). Posterior capsulotomy was performed in 11.5% of the DFNa group and 17.6% of the BMS group (p = 0.8375). The photographic grading of PCO showed no difference. CONCLUSION: The incidence of PCO in eyes treated with DFNa appears to be equal to that after BMS treatment.     

A silicone-based wire-reinforced tracheal tube with a hemispherical bevel reduces nasal morbidity for nasotracheal intubation

We tested the hypothesis that a silicone-based wire-reinforced tracheal tube with a hemispherical bevel is superior to a polyvinyl chloride (PVC)-based precurved tube with a conventional diagonal bevel for nasotracheal intubation. Eighty anesthetized paralyzed adults (ASA physical status I-II) requiring nasotracheal intubation for tonsillectomy were randomly allocated into two equal-sized groups for airway management with the silicone tracheal tube or PVC tracheal tube. Intubation was subdivided into three phases: 1). passage through the nose into the pharynx, 2). laryngoscope-guided passage into the glottic inlet, and 3). laryngoscope-guided passage into the trachea. A specific sequence of airway maneuvers was followed at each stage if it was unsuccessful. The number of attempts and intubation time were documented by an unblinded observer. The frequency of epistaxis and postoperative nasal complications was documented by blinded observers. There were no intubation failures. The number of attempts at pharyngeal (47 versus 56; P = 0.04) and tracheal (43 versus 55; P = 0.005) placement was smaller for the silicone tracheal tube, but the number of attempts at glottic placement was more (72 versus 49; P < 0.0001). Intubation time was similar. The frequency (32% versus 80%; P < 0.0001) and severity of epistaxis were less for the silicone tracheal tube. The total number of postoperative nasal symptoms was smaller for the silicone tracheal tube (10 versus 21; P < 0.05). We conclude that the pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with the silicone tracheal tube than the PVC tracheal tube but that the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube. IMPLICATIONS: The pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with a silicone-based wire-reinforced tracheal tube with a hemispherical bevel than with a polyvinyl chloride-based precurved tracheal tube with a conventional diagonal bevel, but the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube.     

Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments

AIM: To evaluate outcome of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens material. METHODS: Clinical records associated with consecutive 8536 phacoemulsification procedures were reviewed retrospectively. RESULTS: 17 (0.20%) eyes had a posterior capsule rupture with retained lens material in the vitreous cavity that required vitrectomy. Final visual acuity was 0.5 or better in 14 eyes (82%) and 0.4 to 0.1 in three eyes (18%). Retinal detachment occurred in one eye during vitrectomy and two after the surgery. Cystoid macular oedema was observed in two eyes and none developed glaucoma. The corneal endothelial cell loss was 5.7% (SD 6.8 %) (n=15) at 3-6 months postoperatively. CONCLUSIONS: Combined vitrectomy and intraocular lens implantation at the time of phacoemulsification complicated by intravitreal lens material is an option to be considered to reduce the risk of postoperative complications including secondary glaucoma and corneal endothelial cell damage.     

Determination of the oral side safety margin in the resection of a Borrmann 4 type gastric cancer

The oral margins of Borrmann 4 type gastric cancers have been examined, and it was found that the contraction rate of the stomach was 21% from tissue preparations that were made from fresh resected specimens. Further, the widest difference between the macroscopic and microscopic safety margin distance was 35 mm in the cases that were examined. The edge of cancer invasion into the oral side was found to be located under the mucosa in these cases and the mean distance of the safety margin was 13 mm, which was determined on performing a curative resection without a thoracotomy. From these results it has been deemed necessary to leave a safety margin of approximately 5 cm measured from the macroscopic invasion into the oral side.