Minimally Invasive Cardiac Surgery in the Adult: Surgical Instruments, Equipment, and Techniques

To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.     

Inhibition of rabbit gastric epithelial restoration by a water extract ofHelicobacter pylori: evidence using a cultured cell model

The detailed mechanism ofH. pylori-induced gastric damage is still unknown. In this study, we showed that a water extract ofH. pylori retarded the epithelial restoration in a cultured rabbit gastric epithelial cell model with the inhibition of both cell migration and proliferation. Although this inhibitory substance has not yet been biochemically characterized, it is different from knownH. pylori associate-cytotoxins and ammonia. From these results, we hypothesize that these bacteria, directly play a role in disturbance of peptic ulcer healing in vivo. This paper was presented at the Symposium on ‘Cell injury and protection in the gastrointestinal tract: from basic science to clinical perspectives’, October 8–11, 1995, Pécs, Hungary.     

Scintigraphic evaluation of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head

Scintigrams and radiographs of 36 femoral heads in 34 patients before and after Sugioka's transtrochanteric rotational osteotomy for osteonecrosis of the femoral head were investigated prospectively. Patients were followed for more than 3 years after the operation. The patterns of early scintigrams made within 3 months of the operation were classified into four categories. All 4 patients with a large cold area evidenced collapse within I year despite good recovery of the weight-bearing surfaces immediately after operation on conventional radiograms. Twenty-two hips with no cold area in the femoral head did not demonstrate collapse. Femoral head collapse after rotational osteotomy can be predicted by early postoperative bone scintigraphy.     

Human T-Lymphotropic Virus Type II in Japan

Serum specimens were assayed for human T-lymphotropic virus type II (HTLV-II) infection in 1,500 individuals known to be seropositive for HTLV-I and 30,000 blood donors in Japan. All HTLV-I-positive individuals were negative for HTLV-II. However, one of the blood donors was clearly seropositive for HTLV-II. Further, the donor was shown to be positive for HTLV-IIb. Here we report at least one case with HTLV-II in Japan and discuss the origin of the infection.     

A case of motor neuron disease with dementia--cerebral blood flow and cerebral oxygen metabolism]

A 51-year-old man developed muscle weakness of the bilateral upper extremities, and mental changes beginning with personality change. There was no history of mental illness in his family. A neurological examination 1 year after the onset revealed muscle atrophy and fasciculation of his bilateral upper extremities Neuropsychological examination revealed concrete speech, paraphasia, and lack of judgment. Disorientation, amnesia, dyscalculia, and spatial agnosia, however, were not recognized. These neuropsychological findings were compatible with dementia of frontal lobe type. EMG and muscle biopsy revealed neurogenic muscular atrophy. There was no abnormal findings in the brain X-CT and the brain MRI. PET study using C15O2 and 15O2 revealed reduction of cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) in the bilateral medial frontal cortex, the left temporal cortex and the bilateral thalamus. From these these findings the patient was diagnosed as having motor neuron disease with dementia. Muscle atrophy and dementia worsened gradually. A second PET study 2 years and 6 months after the onset revealed severe reduction of CBF and CMRO2 in the bilateral temporal cortex and the thalamus. These PET findings suggested that dysfunction of the temporal cortex and the thalamus related to dementia in this case.     

Mesangial cell behavior in a three-dimensional extracellular matrix.

To understand the role of mesangial matrix in regulating responses of mesangial cells (MCs), particularly as a cause of disease, we examined the behavior of MCs cultured in a three-dimensional extracellular matrix (ECM). Mouse and rat MCs were incorporated into ECM composed of type I collagen gel matrix (CGM) and basement membrane-type gel matrix (BGM), and their shape and proliferation were assessed. The effect of gel matrix on MC migration was also studied. MCs exhibited marked elongation and proliferation in CGM, whereas these behavior were inhibited by increasing the ratio of BGM. Although CGM allowed MC migration, BGM restricted it to a great extent. To identify the cause of our findings, we examined the effects of ECM components in our experimental system. Laminin, fibronectin, type IV collagen, and heparin-like proteoglycans (heparan sulfate and heparin) were each mixed separately with CGM at a concentration of 50 micrograms/ml gel. Whereas fibronectin promoted MC elongation and proliferation, and laminin inhibited MC migration, type IV collagen and heparin-like proteoglycans inhibited all three activities of MCs. Our findings suggest that basement membrane-type mesangial matrix is important in regulating the behavior of MCs in vivo.     

A case of Borrmann type 4 gastric cancer well responded to chemotherapy with tegafur

A 62-year-old female had unresectable stage 4 gastric cancer with ascites. She was treated with suppository administration of tegafur 750 mg/day. Endoscopical examination before treatment showed Borrmann 4 gastric cancer. After 3 months' treatment, the lesion almost disappeared. The patient survived for 9 months after the diagnosis.     

L-arginine-induced current in portal venous smooth muscle cells.

In our previous report, we showed that L-arginine induced depolarization of smooth muscle cells of the rat portal vein with an increased contraction. To clarify the ionic mechanism of the membrane depolarization, the effect of L-arginine on the holding current was studied in freshly isolated smooth muscle cells of the rat portal vein. The whole-cell patch-clamp technique was used, with the membrane potential held at -60 mV. In the presence of Na+ in the perfusate, L-arginine 10 mM induced an inward current in about 50% of the cells. In Na+-deficient perfusate, L-arginine 10 mM increased the amplitude of the inward current in a Na+ concentration-dependent manner. BCH, an inhibitor of the Na+-dependent amino acid transporter, ceased the L-arginine-induced current. These results indicate that L-arginine induces an inward current via Na+-dependent mechanisms in rat portal venous smooth muscle cells.