Expansive open-door laminoplasty for cervical spinal stenotic myelopathy

Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space.     

Effect of tetrakis-μ-3,5-diisopropylsalicylatodiaquodicopper(II) on the status of reduced glutathione in freshly isolated hepatocytes

Effects of different concentrations of tetrakis--3,5-diisopropylsalicylatodiaquodicopper(II) (Cu(II)₂(3,5-DIPS)₄(H₂O)₂) on the reduced status of glutathione (GSH), the major nonprotein thiol in tissues, were investigated using freshly isolated hepatocytes. Cu(II)₂(3,5-DIPS)₄ below 100 M did not have any significant effects on either the GSH content or viability of the hepatocytes, but at 150–250 M it decreased both parameters after 1 h of incubation. The decrease in cellular GSH was not followed by an increase in the oxidized form of GSH (GSSG) in the cell suspension. The addition of deferoxamine with Cu(II)₂(3,5-DIPS)₄ to the hepatocyte suspension prevented depletion in GSH content and loss of cell viability by Cu(II)₂(3,5-DIPS)₄. Both GSH depletion and loss of cell viability were found to be Cu(II)₂(3,5-DIPS)₄ dose dependent. From these results, it appears that Cu(II)₂(3,5-DIPS)₄ penetrated the cell membrane and acted by decreasing the GSH level by forming a copper-glutathione complex.     

Changes of enzyme activity levels in red blood cells in hemodialysis patients by recombinant human erythropoietin.

In a phase II clinical trial to test the ability of recombinant human erythropoietin (r-HuEPO) to reverse the anemia of patients undergoing hemodialysis, the changes of enzyme activity in red blood cells were evaluated in 5 hemodialysis anemic patients who were treated with r-HuEPO. Concerning the activity levels measured, the following conclusions are drawn. 1) HK, ALD, TPI, G6PD and 6PGD were statistically significantly increased at the time when the hematocrit has risen by 8% with the use of r-HuEPO. 2) The enzyme activity levels of PFK, GA3PD, MPGM, ENOL, PK, GR and ADA were higher than normal already before the r-HuEPO treatment. 3) The increases of HK and G6PD by r-HuEPO, as age dependent enzymes, may reflect the generation of young red blood cells. 4) In view of the fact that they are related to ATP production in the glycolysis cycle, we infer that increases of red blood cell enzymes by r-HuEPO may play at least some part in bringing a sensation of "well-being" to severely anemic patients undergoing hemodialysis.     

A case of severe near-drowning: the speech ability was regained on the 65th hospital day]

A 3 y.o. boy suffered cardiac arrest after submersion in a winter pond for more than fifteen minutes. He was transferred to our hospital and was successfully resuscitated. Although his neurological condition was severely damaged at the beginning, he started searching objects with his eyes on the 18th hospital day, speaking on the 65th hospital day and walking by himself on the 76th hospital day. His consciousness fully recovered eventually. The treatments consisted of "HYPER" as suggested by Conn AW, et al. and active anti-hypertensive therapy. These treatments and the cold temperature of winter time might have contributed to the good neurological recovery of the patient.     

Clinical study of growing up aneurysms: report of 25 cases

Twenty-five cases of patients with growing up aneurysms are reported. Growth of the aneurysm was confirmed by repeated angiography within 1 month in 11 cases (short-term group), and for over 1 month in the other 14 cases (long-term group) following the initial angiography. Clinical history, shape and growth pattern of aneurysms, as well as hemodynamic factors that effect the growth were investigated in each group. The aneurysms were classified according to the shape into dome-type (smooth contour) and bleb-type (irregular contour). In all cases of the short-term group, the first angiography was performed because of rupture of the aneurysm. In this group, 4 cases bled again because of enlargement or the development of an aneurysmal bleb. Growth rate and the initial size of the aneurysm did not effect the potential of re-rupture. In the long-term group, 9 cases out of 14 (64.3%) had "non-ruptured aneurysm" at the time of first angiography. In the follow up, 5 cases were ruptured (two because of re-bleeding and three for the first time). In 3 out of these 5 cases, a bleb was demonstrated on initial angiography, and in another case, a bleb was demonstrated in follow-up angiography. Only one case ruptured because of the growth of the aneurysmal dome. Most of the aneurysms that rupture, in the follow-up survey, showed a larger growth rate in comparison with aneurysms that did not rupture. Many cases of this long-term group were associated with hypertension or vascular abnormalities which would effect the aneurysmal growth.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of reflux nephropathy associated with pheochromocytoma]

A 26-year-old female patient complicated with reflux nephropathy and pheochromocytoma is reported. We could not find either intrinsic or extrinsic factor of urinary tract obstruction. The open bilateral renal biopsy was performed at the time of resection of the tumor. The renal biopsy specimen demonstrated minor glomerular change, severe tubular "thyroid-like" appearance and cast formation in the obvious reflux side. Otherwise focal glomerular sclerosis (FGS) lesion was found in less reflux side. In reflux nephropathy, FGS lesion is reported as main cause of progression, but mechanism of FGS lesion is unknown. This case which has both vesicoureteral reflux the high plasma nor-epinephrine concentration was considered to be important to emphasize circulative factor in the pathogenesis of FGS like lesion.     

Three-dimensional observations on microvascular growth in rat glioma using a vascular casting method

The microvascular growth of ethylnitrosourea-induced rat glioma was observed using vascular casting and scanning electron microscopy (SEM). Light microscopy showed central necrosis and marginal invasive tumor cell growth with increased vascularity, and suggested that adopted pre-existing circulation was dominant in the inoculated brain tumors. In SEM, numerous buds or nodular protrusions and a few large and tortuous vessels along the tumor margin were seen at the early stage. In the intermediate stage, microaneurysms, buds with septum formation and anastomotic arches appeared, and these tumor vessels became more tortuous and larger, and extended as the tumor grew. Several "potato-shaped" huge vessels and linear nodular large vessels also appeared. In the late stage, glomeruli appeared and potato-shaped huge vessels increased in number. The neovascularization and microvascular growth of the tumors was characterized by three patterns: (a) growth of the parent vessels forming buds, (b) vascular growth in a meshwork formation producing glomeruli, and (c) vascular enlargement without a definite pattern creating potato-shaped huge vessels. The tumor vessels gradually lost their natural three-dimensional structure.     

The effects of sphincteroplasty on manometric profile of common bile duct and the duodenum (author's transl)

A simultaneous manometric monitoring of the common bile duct (CBD) and the duodenum were performed 2 weeks after choledocholithotomy on 15 patients whose common bile ducts were explored without sphincteroplasty and 30 patients with sphincteroplasty. These manometric studies were carried out by open-tip catheters intubated into the CBD and duodenum through the T-tube at the operation. In patients without sphincteroplasty, no effects of the duodenal pressure on a CBD pressure profile were recognized, while a synchronized pressure profile of the CBD and the duodenum was obtained in patients with sphincteroplasty. By stimulation with morphine (Morphine sulfate; 0.17 mg/Kg iv bolus), waxing and waning of the pressured in the CBD without sphincteroplasty were observed with 20 cmH2O in maximum at about 13 minutes after injection. However, in the CBD with sphincteroplasty, scale-over increase of the pressure curve was seen immediately after duodenal contraction caused by morphine stimulation. A direct infusion of 5 ml of 0.1 N hydrochloride to the duodenum causes hyperperistalsis of the duodenum, which made a synchronized pressure profile in the CBD with sphincteroplasty but made no remarkable change in a pressure profile of the CBD without sphincteroplasty. These findings conclude that the sphincter of Oddi plays an important role as a "pressure barrier" between the CBD and the duodenum, and that with the destruction of this sphincter by sphincteroplasty, a pressure profile of the CBD becomes close to that of the duodenum. This simultaneous manometric study of the CBD and the duodenum might be one of most valuable methods for evaluation of completeness of the sphincteroplasty.