Entrapment neuropathy of the tibial nerve by a Baker's cyst: case report]

Entrapment neuropathies of the tibial nerve by Baker's cysts occur infrequently. We present a patient with entrapment neuropathy of the tibial nerve by a Baker's cyst which is preoperatively evaluated by nerve conduction study and magnetic resonance imaging. We present this case with a review of the literatures.     

Analysis of results of surgery performed over a 20-year period on 500 patients with cancer of the thoracic esophagus

This study was conducted to examine the long-term outcome of 500 patients who underwent surgery for cancer of the thoracic esophagus during the past 20 years. Favorable results were obtained with postoperative adjuvant radiation and chemotherapy and there were no surgical deaths in the last 5 years. The mortality rate decreased from 17% prior to 1980 to 5% between 1981 and 1993, this being most probably attributable to the decreased incidence of suture leakage. With respect to changes in surgical techniques, during the initial years we performed intrathoracic anastomosis, after which sternal manubrium resection with anterior mediastinal esophagogastrostomy was carried out. Subsequently, we invented a technique for performing esophagogastrostomy via the posterior mediastinum. The posterior mediastinum was selected as the most physiologic route, based on measurement of tissue oxygen tension. Using blood flow determinations obtained by laser-Doppler velocimetry, we concluded that the effectiveness of thicker gastric tubes was superior to that of thin tubes. Esophagogastrostomy was performed in a shallow field in the cervical region, with the anastomosis ultimately positioned in the superior mediastinum and covered with mediastinal pleura.     

Effects of angiotensin-converting enzyme inhibitor on plasma b-type natriuretic peptide levels in patients with acute myocardial infarction

Background: Plasma levels of B-type natriuretic peptide (BNP) are markedly increased in patients with heart failure and acute myocardial infarction. The changes in plasma BNP levels in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors have not been examined well. This study was designed to examine the effects of early angiotensin-converting enzyme inhibitor therapy on plasma BNP levels in patients with acute myocardial infarction.Methods and Results: We measured the plasma levels of B-type natriuretic peptide over the time course for 2 weeks in 30 patients with acute myocardial infarction in whom either imidapril (n = 15) or placebo (n = 15) was given at random immediately after admission. Plasma BNP levels increased and reached a peak of 192 ± 28 pg/ML 16 hours after admission; thereafter, the levels decreased and then again increased, forming the second peak of 217 ± 38 pg/ML on the fifth day (biphasic pattern). On the other hand, plasma BNP levels increased and reached a peak level of 190 ± 22 pg/ML 16 hours after admission and then decreased from 2 days after admission until the second week in the imidapril group (monophasic pattern). Left ventricular ejection fraction measured in the second week was significantly higher in the imidapril group than in the control group (62.2 ± 1.1% vs 51.2 ± 3.6%, P < .01).Conclusions: It is concluded that plasma BNP levels followed a monophasic pattern after imidapril treatment, whereas a biphasic pattern was followed after placebo, and that plasma BNP levels constitute a marker of ventricular dysfunction in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors.     

Detection of experimental atheroma in atherosclerotic rabbits: The fluorescence spectrum of haematoporphyrin derivative obtained in situ by angioscopic fluorescence spectrophotometry

An endoscopic laser fluorescence spectrophotometer has been developed to measure the fluorescence spectrum of haematoporphyrin derivative (HPD) in situ. In this study the demonstration of HPD accumulation in experimentally induced atheroma within the aortas of atherosclerotic rabbits is reported. Atheromas were induced in rabbit aortas after aortic intimai injury by balloon catheterization and hypercholesterolemic diets. Subsequently, an ultra-thin diagnostic angioscopic catheter was introduced into the descending aortas of these rabbits under anaesthesia, 24 h after the intravenous injection of 5 mg kg^–1 HPD. Characteristic red-shifted peaks of the fluorescence of HPD at 630 nm, 665 nm and 690 nm were detected in the fibrous plaques. In fatty streaks, however, the 630 nm and the 690 nm emission intensities were lower and the 665 nm peak was notably absent. Red-shifted HPD fluorescence was not detectable in normal areas of diseased aorta and in control animals. In addition, the emission spectra of HPD incubated with various lipid components representing the constituents of these atheromas were obtained. The resemblance of the emission spectrum of HPD incubated with sphingomyelin and cholesterol to that of the atheromatous lesions suggest that HPD may interact with these lipids in order to produce the red-shifted fluorescence maxima seen within atheromas. The possibility of future applications with this equipment for the diagnosis of atheroma is supported by this investigation.     

Effects of Lactogenic Hormones on Morphological Development and Growth of Human Breast Epithelial Cells Cultivated in Collagen Gels

We investigated the hormonal dependence of the growth and morphological development of human breast epithelial cells (HBEC) cultivated in collagen gels floating on serum–free medium. HBEC used had grown out from breast carcinoma tissue and from histologically non–malignant tissue fragments in the same mastectomy specimens. In the presence of ail three lactogenic hormones, hydrocortisone (HC), insulin (INS), and prolactin (PRL), both carcinoma–derived and histologically non–malignant tissue–derived HBEC grew and formed cell masses with protruding tubule–like extensions that consisted of a multilayer of cells. Deletion of any one of the hormones from the medium had no effect on cell growth of HBEC derived from either tissue type. However, morphological development, especially the morphology of the tubule–like extensions, was altered in the histologically non–malignant tissue–derived HBEC by deletion of HC or INS, and by deletion of HC, but not INS, in the carcinoma–derived HBEC. The present results suggest that the carcinomaderived HBEC have decreased responsiveness to INS as compared to that of HBEC derived from histologically non–malignant breast tissue.     

Immunological characterization of papain-induced fragments of Clostridium botulinum type A neurotoxin and interaction of the fragments with brain synaptosomes.

After treatment of Clostridium botulinum type A neurotoxin with papain, three fragments (Mrs, 101,000, 45,000, and 43,000) were purified by hydrophobic and ion-exchange chromatography with a high-performance liquid chromatographic system. Immunoblotting analyses with monoclonal antibodies showed that the 101,000-dalton fragment consisted of the light chain and a part of the heavy chain (H-1 fragment) linked together by a disulfide bond, and the other two fragments were correlated to the remaining portion of the heavy chain (H-2 fragment). The 45,000- and 43,000-dalton fragments effectively competed for binding of the 125I-labeled neurotoxin to synaptosomes, while no inhibition was observed with the 101,000-dalton fragment. The results indicate that the H-2 fragment interacts with the binding site on the neural membrane. The binding of the neurotoxin was impaired by treatment of synaptosomes with neuraminidase. Incorporation of gangliosides into neuraminidase-treated synaptosomes resulted in the restoration of binding. The results suggest that gangliosides are one of the components of the toxin-binding site.