Willingness to pay for health care services in common cold, retinal detachment, and myocardiac infarction: an internet survey in Japan

Background  

The application of Willingness To Pay (WTP) measurement with Contingent Valuation Method (CVM) to medical services is gradually increasing. Knowing what influences WTP is an important matter because validity of CVM in medical services remains controversial. The objective of this survey is to measure WTP for the treatment of typical acute illnesses and to analyze the factors affecting WTP.     

Rotational acetabular osteotomy for hip dysplasia: spontaneous medial enlargement of the acetabulum

We followed 56 patients (63 joints) who had undergone rotational acetabular osteotomy (RAOs) between 1987 and 1993, mean 7 (5-12) years. The Merle d'Aubigné score increased by 15 points or more in 59 and decreased in 4 hips. The arthrosis progressed in 5 joints. In about 2/3 of the cases, we observed some medial and/or lateral expansion of the subchondral bone in the acetabulum 3 years postoperatively, suggesting enlargement of the load-bearing area.     

Histologic change of the meniscus and cartilage tissue after meniscal suture

The influence of suturing on cell infiltration into the meniscus and surrounding tissue is not well known. Histologic changes in the meniscus after suturing and prediction of histologic changes using magnetic resonance imaging were studied. Forty knees in 20 mongrel dogs were studied using four types of 4-0 suture material: nonabsorbable monofilament, nonabsorbable braided, absorbable monofilament, and absorbable braided. Each type of suture material was used for meniscal suture on eight knees each. The other eight knees were not subjected to meniscal suture. Specimens obtained at 1 and 3 months were studied by magnetic resonance imaging and light microscopic analysis. The maximum width of change of meniscal tissue was measured. Changes from the nonabsorbable suture group were smaller than that of the absorbable suture group in magnetic resonance imaging. Histologic changes as seen by light microscope were larger in the absorbable group than in the nonabsorbable group at 1 and 3 months after surgery. Injury was found in the articular cartilage of the femoral condyle in the nonabsorbable braided suture group. Histologic changes were significantly greater when changes in magnetic resonance imaging signal intensity were larger. The current study showed that non-absorbable monofilament suture material results in the least damage to the meniscus and surrounding tissue.     

Spontaneous rupture of the urinary bladder

A case of non-traumatic rupture of the urinary bladder is reported. The patient, a 52-year-old woman, was admitted to our clinic with the chief complaints of dysuria and gross hematuria after hemorrhoidectomy. Ultrasonography and CT scan showed a huge mass in Retzius' cavity. Then, rupture of the bladder was diagnosed through subsequent cystoscopy and cystography. During surgery, we recognized a large defect in the anterior wall of the urinary bladder associated with reddish-yellow fluid in the pelvic cavity. Histological findings showed no malignant change in the bladder. Various factors were suspected to be related to this spontaneous rupture of the urinary bladder.     

Maintenance hemodialysis poses few limitations for liver surgery

A hepatic mass was detected in two patients on regular hemodialysis for chronic renal disease. Hepatic resection was carried out with no untoward effects. We wish to emphasize that meticulous perioperative management of chronic renal failure has to be designed for such patients.     

Endothelium-fibrinolysis system interaction

The role of urokinase-type plasminogen activator (u-PA) in capillary growth was investigated using cultured bovine endothelial cells (BCE) on type I collagen gels and analyzed by morphometry for quantitative assessment of angiogenesis in vitro. BCE migrated into the gel matrix and formed capillary-like networks. The morphometrical analyses by measuring the length of tube formation enabled us to evaluate the effects of fibrinolytic proteases and several reagents. The addition of plasminogen up to 25 micrograms/ml to the gels significantly increased the extent of tube formation of BCE in a dose-dependent manner. Basic fibroblast growth factor (10 ng/ml) increased tube formation only in the presence of plasminogen. These enhancing effects on angiogenesis appeared to be related to the activation of fibrinolysis by u-PA derived from BCE, because they were suppressed by the addition of anti-u-PA IgG and anti-plasmin reagents such as aprotinin and alpha 2 anti-plasmin. Transforming growth factor beta also enhanced tube formation of BCE, but tumor necrosis factor alpha and interleukin-1 suppressed the tube formation. The quantitative assay of angiogenesis may be useful for clarifying the mechanism of neovascularization under pathological conditions.