Influence of oro-facial sensory input on the output of the cortical masticatory area in the anesthetized rabbit

In order to study the role of sensory inputs to the cortical masticatory area (CMA) and plasticity in the CMA, the representation of sensory inputs and the change of sensory inputs and motor outputs in the CMA 16 days after trigeminal deafferentation in the rabbit were examined. Neuronal activity was recorded in response to mechanical and electrical stimulation of the oro-facial region and cortically-induced rhythmical jaw movements (CIRJMs) were analyzed. Cortical neurons with receptive fields in the deafferented region were not found in the CMA. However, the projection area of the intact lingual nerve extended both antero-posteriorly and medio-laterally in the CMA and included neurons with long latency responses to lingual nerve stimulation. In a previous study in the rabbit, CIRJMs were classified into two groups according to their similarity to normal masticatory patterns: one pattern resembled that occurring during the food transport stage (T-pattern), and the other resembled that occurring during the chewing stage (C-pattern). These two patterns of CIRJMs were evoked from different stimulation sites: T-patterns were induced from the dorsal CMA and C-patterns were induced from the ventral CMA. The relationship between the patterns of CIRJMs and the site of stimulation in the deafferented rabbits was similar to that observed in normal rabbits. This finding suggests that sensory inputs to the CMA may not directly influence the CMA motor outputs controlling jaw movements, despite a close spatial relationship between the input and output of this area.     

Ovarian function in three female patients with McCune-Albright syndrome with persistent autonomous ovarian activity

Autonomous ovarian activity persists throughout adolescence in some patients with McCune-Albright syndrome (MAS). There have been few studies of longitudinal assessment of ovarian function in these patients. We investigated the first morning voided urinary gonadotropin and ovarian steroid levels consecutively in three patients aged 3 to 7 years after withdrawal of therapy for precocious puberty. They had the triad of MAS with onset of menses within the first 3 years of life. Excessively elevated urinary estrogen levels with one or two peaks per cycle were found in all patients. In two patients, café-au-lait spots and dysplastic bones were located unilaterally. These two patients showed significantly increased urinary pregnanediol levels, suggesting ovulation, with low levels of gonadotropins in one patient and moderately low levels with an LH surge in the other. Thus, only a unilateral ovary was anticipated to be mutated with persistent autonomous ovarian activity. In the remaining patient with bilateral involvement of tissues, relatively high LH and low FSH levels throughout a cycle were found with no rise in urinary pregnanediol.     

Reliability of Amplicor Mycobacteria Kit for detection of Mycobacterium tuberculosis complex and Mycobacterium intracellulare: results of cooperative study among 331 laboratories in 2000

Amplicor Mycobacterium Kit (Roch Diagnostics: Japan) is the most widely used kit in Japan for the diagnosis of mycobacteria infections, especially those caused by Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium intracellulare. We evaluated the reliability of the kit in co-operation with 331 laboratories using the kit in routine examination. We distributed specially prepared 4 test samples to each laboratories. The negative sample was NALC-NaOH treated sputum which showed "negative" when tested by this kit and positive samples were NALC-NaOH treated sputum containing M. bovis or M. intracellurare. False-positive results were reported in 6 out of 331 laboratories (1.8%) and false-negative results were reported from 7 laboratories (2.1%). (The details were 1 out of 331 labs for TB-H sample, 5 out of 331 labs for TB-L sample and 1 out of 316 in MIN sample.) Statistical significance between MWP method and COBAS method was not significant. After receiving and evaluating the test results on the 4 samples, the follow up questionnaires were sent out to 22 laboratories which reported incorrect results and low optical density (O.D.) on positive control. Results of this questionnaire suggested that it was important to follow the package insert instructions and to follow the correct procedures for PCR assay. These results suggested that Amplicor Mycobacterium Kit is reliable for rapid diagnosis of Mycobacteria infections.     

Enhanced regional washout of technetium-99m-sestamibi in patients with coronary spastic angina

BACKGROUND: Reverse redistribution and rapid washout of 99mTc-sestamibi are observed in patients with acute myocardial infarction and may indicate viable myocardium. However, the clinical significance of this phenomenon has not been rigorously examined in other cardiac diseases. Thus, we investigated whether reverse redistribution and washout of 99mTc-sestamibi could be used in the diagnosis and follow-up of patients with coronary spastic angina. METHODS: Thirty patients diagnosed as coronary spastic angina were examined. During coronary arteriography, spasm was induced by provocation test with ergonovine, and only total or subtotal occlusion was considered positive. Myocardial perfusion tomography was obtained 45 min (early) and 3 hr (delayed) after 99mTc-sestamibi injection. Segmental defect score was visually graded from 0 (normal) to 4 (defect), and a total defect score was determined as the sum of defect scores for all segments. Washout rate of 99mTc-sestamibi from the myocardium was calculated for each segment. After medical treatment with calcium antagonists and nitrates for 3 months, 99mTc-sestamibi imaging was repeated. RESULTS: Out of 30 patients, on the early images 17 (57%) patients demonstrated decreased 99mTc-sestamibi uptake in spastic segments; on the other hand, 24 (80%) patients did decreased 99mTc-sestamibi uptake in spastic segments on delayed images. Total defect scores in delayed images were higher than those in early images (6.9 +/- 0.3 vs. 3.6 +/- 0.4, p < 0.01). Reverse redistribution of 99mTc-sestamibi was observed in 17 out of 30 patients (57%) with coronary spastic angina. Washout rate of 99mTc-sestamibi from spastic segments was higher than that from non-spastic segments (16 +/- 2% vs. 11 +/- 5%, p < 0.01). After medical treatment, washout rate from spastic segments was decreased to 10 +/- 4 (p < 0.01), and left ventricular ejection fraction was increased from 63 +/- 8% to 73 +/- 4% (p < 0.01). CONCLUSION: Rapid washout of 99mTc-sestamibi was observed in patients with coronary spastic angina and might indicate that the ability of myocyte to retain the tracer was impaired due to repetitive brief ischemia by coronary spasm. The early and delayed 99mTc-sestamibi imaging provides useful information for the diagnosis and responses to the treatment in patients with coronary spastic angina.     

Recruitment maneuver and high PEEP in a patient with severe reperfusion pulmonary edema after pulmonary thromboendarterectomy

Recently open lung approach such as recruitment maneuver and high PEEP has been applied in patients with acute respiratory distress syndrome. We report here a 29-year-old man with chronic pulmonary thromboembolism (CPTE). In this case, recruitment maneuver and high PEEP relieved postoperative respiratory failure. The major complications after pulmonary thromboendarterectomy (PTE) for CPTE are: reperfusion pulmonary edema (RPE), pulmonary hypertension (PH), hypoxia and bronchial bleeding, all of which the patient has demonstrated. Preoperative examination showed high pulmonary artery pressure (85/41, mean 50 mmHg), and high pulmonary vascular resistance predicted poor postoperative course. After PTE, he developed severe RPE, PH, hypoxia and bronchial bleeding, resulting in failed weaning from cardiopulmonary bypass. Therefore he required mechanical support of percutaneous cardiopulmonary support (PCPS). In ICU we repeated recruitment maneuver (PEEP: 30 cmH2O, peak inspiratory pressure: 42 cmH2O, respiratory rate; 15 breaths.min-1, for 1 min) and kept high PEEP (15 cmH2O). After initiating this ventilatory strategy, RPE was gradually relieved, followed by improvement of oxygenation and PH. We successfully weaned him from PCPS 38 hr after surgery and he was discharged alive on the 90 post-operative day. We conclude that recruitment maneuver and high PEEP may be useful for RPE developed after PTE.     

Clinical evaluation using magnetic resonance imaging for patients with stage III cervical carcinoma treated by radiation alone in multicenter analysis: its usefulness and limitations in clinical practice

To evaluate the ability of magnetic resonance imaging (MRI) to predict the clinical outcome, we perform retrospective multicenter analysis of patients with stage III disease treated with radiation alone. From three institutions, 80 patients with stage III disease diagnosed with MRI were entered in the study. Seventy-eight patients received intracavitary brachytherapy with external beam radiotherapy. Univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). The 5-year OAS, DFS, PC, and DMFS rates were 59.5%, 48.7, 74.2%, and 62.5%, respectively. Bilateral pelvic fixation to the pelvis (p = 0.001) and patient age 50 years or less (p < 0.0001) were significant adverse factors for OAS. As a function of DFS, these were positive lymph nodes (p = 0.02), bilateral fixation to the pelvis (p = 0.03), and younger patient age (p < 0.0001), respectively. Patient age 50 years or less proved to be the only significantly unfavorable factor for PC (p < 0.0001). Larger size/volume (p < 0.05), positive lymph nodes (p = 0.03), bilateral pelvic disease (p = 0.02), and younger patient age (p = 0.004) were significantly adverse factors for DMFS. Using multivariate analysis, patient age 50 years or less, disease with bilateral fixation, and calculated volume more than 100 ml proved to be significantly adverse factors for OAS and DFS. In the analysis of PC, only patient age 50 years or less was a significantly adverse factor (p = 0.0014, relative risk [RR] = 14.93). Bilateral fixation to the pelvis (p = 0.0055, RR = 4.032), positive lymph nodes (p = 0.0494, RR = 2.637), and large calculated volume (>100 ml; p = 0.0057, RR = 4.831) proved to be significantly adverse factors for DMFS. For patients with stage III disease, size/volume and lymph node status derived from MRI showed a significant correlation with the development of distant metastasis, but failed to predict locoregional control. In addition, size/volume analysis showed no apparent relationship with disease-free survival. For patients with stage III disease, MRI may provide beneficial information predicting distant metastasis, but not for local control.     

Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy

PURPOSE: To compare the efficacy of MRI and FIGO stage, we performed retrospective multicenter analysis of patients with Stage II-III disease treated with radiation alone. METHODS AND MATERIALS: From three institutions, 164 patients diagnosed with cervical carcinoma were entered into the study. The majority of this cohort received intracavitary brachytherapy combined with external beam radiotherapy (n = 161). Uni- and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESULTS: The 5-year OAS, DFS, PC, and DMFS rates were 68.8%, 60.4%, 77.4%, and 71.7%, respectively. Using uni- and multivariate analyses, both large tumor size/volume and positive lymph node enlargement (LN) showed a significantly unfavorable influence on survival and local and/or distant failure (p < 0.05). Using these two prognostic factors, patients were divided into three subgroups; the 5-year DFS rates of patients with risk 0 (volume 50 cc or positive LN), and 2 (volume >50 cc and positive LN) were 72.9%, 53.3%, and 26.1%, respectively (p < 0.0001). Among patients with volume 0.05). CONCLUSION: MRI will provide more useful and practical information than will FIGO stage classification for patients with bulky disease, although this will remain a prognostic factor for patients with nonbulky disease (volume 相似文献