Expandable metallic stent treatment for malignant colorectal strictures

Four patients were treated by placement of an expandable metallic stent (two Gianturco Z-stents, two Ultraflex stents) for malignant colorectal strictures. All four patients were able to defecate after stent placement. Stent migration was recognized in one patient. Two patients suffered from tenesmus after stent placement.     

Neurons in the temporal cortex changed their preferred direction of motion dependent on shape

To investigate neuronal mechanisms that integrate different visual modalities such as motion and shape, neuronal activities in the superior temporal polysensory area (STP) were recorded from monkeys that were watching rotating images. In total, 194 neurons were identified as visually responsive. Of these, 73 neurons (38%) showed differential response depending on both shape and direction of motion (MS neurons). Of these 73 neurons, 21 (29%) were identified as reversal type MS neurons (MSr neurons), that is, they responded to an opposite preferred direction when the shape was different. The results confirm that neurons in the STP can be simultaneously activated by different attributes of visual stimuli. The data also suggest that individual STP neurons can process more than one type of visual stimulus.     

Anterior screw fixation combined with posterior interlaminar fusion for fracture of axis: report of two cases

Two cases of axis fracture are reported. Traffic accidents were the cause of injury in both cases. The odontoid process was dislocated anterolaterally with fracture of the lateral mass of the axis in both cases. In Case 1 good alignment of the atlas and axis could not be maintained even with a Halo-vest. The case 2 patient with spinal cord compression caused by dislocation of the axis was referred to our hospital 8 weeks after the accident. Both cases were surgically treated in a similar fashion. Because of the lateral mass fracture and lateral displacement of the atlas relative to the axis, posterior screw fixation with interlaminar fixation (Magerl) was thought to carry a risk of causing damage to the vertebral artery. Because of this, anterior screw fixation combined with posterior wiring was conducted. First, the odontoid process was fixed anteriorly by a screw because it was able to be placed back in good alignment while the patient was in the supine position. Then, the posterior C1-2 interlaminar wiring with iliac bone graft was added. Rigid fixation was obtained without any complication. Various kinds of fixation, such as posterior interlaminar wiring, odontoid screw fixation and Magerl's fixation, have been reported for the treatment of unstable axis fracture. Among them Magerl's method has been regarded as the most stable. When it is not applicable, combination of the first two methods can be an alternative way of treatment for this odontoid process fracture.     

Effects on health status in students from attending a "juku"]

Between November and December 1993 a questionnaire survey concerning the lifestyle and health status was performed on 1.314 elementary school children living in Tokyo and its suburbs. In this study the following items were included: 1) sleeping habits, 2) physical activity, 3) playing habits, 4) eating habits, 5) attending a "juku", private cram school to prepare children for entrance examinations, 6) commuting hours, 7) 20 subjective symptoms regarding health, and so on. The results were as follows: 1. 61.9% of students were attending a "juku". 2. The number of hours of sleep, playing after school and watching TV decreased with the frequency of attending a "juku". The students who were attending "juku" more than 3 times a week had the shortest number of those hours, and the students who did not attend any "juku" had the longest of those hours. 3. To determine health status, 20 subjective symptoms were scored. The average number of subjective symptoms was 5.0. That of the students who were attending "juku" more than 3 times a week was 5.5. 4. Of the 20 subjective symptoms, 7 items were correlated to the frequency of attending "juku". To remove the effect of other factors, multiple logistic regression analysis was applied to determine correlation of 7 subjective items and other factors including attending "juku". As a result attending "juku" more than three times a week were associated with the two symptoms of "sleepy" and "eye fatigue".     

Novel experimental model using free radical-induced emesis for surveying anti-emetic compounds from natural sources.

A novel experimental model of free radical-induced emesis for screening anti-emetic compounds from natural sources was established. 2,2'-Azobis(2-amidinopropane) dihydrochloride (AAPH) dissolved in liposome induced emesis in young chickens, and the emesis was prevented by antioxidants including N-(2-mercaptopropionyl)-glycine (MPG), alpha-tocopherol, and L-ascorbic acid. Tropiseton, a serotonin receptor antagonist, also prevented emesis induced by AAPH. Known anti-emetic drugs and anti-emetic principles from natural sources also showed significant retching inhibition in the experiment using this system.     

A fundamental study of Copper-T (intrauterine device). Part 1 (author's transl)]

Copper IUDs and polyethylene IUDs were inserted in Clauberg rabbits. Proliferation of endometrium caused by exogenous progesterone was markedly inhibited in the rabbits with the copper IUD. Maximum proliferation was seen in the contralateral uterine horn of the rabbits with polyethylene IUDs. The concentration of Cu-ion in the endometrium in the horn with Cu-IUD showed a higher level as 19.5 ug/g wet wt. than that in the control horn, 2.5 ug/g wet wt. This effect corresponds to the addition of Cu-ion in a concentration of higher dosage to the endometrium of the control horn. In the case of women with normal menstrual cycles, the increase in a concentration of Cu-ion in the endometrium with Cu-IUD was lower than 10-5M; in the control women the concentration was 1.6 ug/g wet wt. of endometrium. The histological dating of endometrial specimens (E-B date) with Cu-IUD was examined and compared with expected date of the cycle determined by BBT date. Cu-IUD did not induce any significant discrepancy in both dating. The mechanism of increasing contraceptive effect with Cu-ion was considered to be a little different than in rabbits. (Author's Modified)     

Cranial fasciitis of childhood]

A rare case of cranial fasciitis in a 1-year-old boy arising in the temporoparietal bone has been described. In 1990, Lauer and Endinger first reported cranial fasciitis, which is a benign subcutaneous tumor of the head developing from the deep fascia or the cranial periosteum and showing a pathological finding characterized by proliferation of fibroblasts. They described this tumor as "cranial fasciitis of childhood" in view of a high incident in infants and child. Cranial fasciitis grows rapidly in the scalp without pain, but its mean size is 2.5-3cm. Cranial fasciitis is closely related a clinical course and pathological findings to nodular fasciitis, which is also a benign proliferative fibroblast tumor developing from the subcutaneous muscular layers of the trunk and extremities (especially, the forearms), which was reported by Konwaler in 1955. However, cranial fasciitis differs from nodular fasciitis in that it is associated with the skull bone and, in many cases, the tumor destroys the inner and outer table of the skull and adheres to the dura mater. Cranial fasciitis should be considered to be a variant of nodular fasciitis. Neurosurgeons should be aware of this entity in the differential diagnosis of a firm lesion of the scalp in children. A brief review of the literature disclosed only 17 cases in the world. This case report is the first one of cranial fasciitis in Japan.     

Evaluation of patients undergoing lung volume reduction surgery: ancillary information available from computed tomography

AIM: A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS: Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n= 28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T(PERF)), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS: Extensive emphysema was present on HRCT (60% +/- 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r(s)= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P= 0.04). CONCLUSION: The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS.     

Surgery of basilar aneurysms associated with unexpected rupture of an internal carotid artery aneurysm

During a surgery of basilar aneurysms via the trans-sylvian approach, we encountered an arterial bleeding caused by rupture of an internal carotid artery aneurysm that had been difficult to diagnose before surgery, as it was a small and brood-neck aneurysm and mimicked arteriosclerosis. In spite of several surgical procedures, the surgical path at the basilar aneurysms became narrow, and we had to abandon the clipping of the aneurysms. Consideration of radiological and intraoperative findings was made for this case, demonstrating a pitfall that neurosurgeons may encounter during surgery. Received: 16 December 1998 / Accepted: 26 May 1999