Radiographic and scintigraphic courses of union in cervical interbody fusion: hydroxyapatite grafts versus iliac bone autografts.

This study investigated the radiographic and scintigraphic courses of union in cervical interbody fusion using hydroxyapatite (HA) grafts or iliac bone autografts. METHODS: Twelve patients underwent both serial plain radiography and bone scintigraphy during the 12 mo after surgery. Serial plain radiographs were obtained every month until the end of the study period. Bone scintigrams with 99mTc-hydroxymethylene diphosphonate (HMDP) were obtained at 2 wk and at 1, 2, 3, and 6 mo. Uptake of 99mTc-HMDP in the graft was expressed as a ratio of the counts in the graft to those in the axis. RESULTS: In the HA graft group, the plain radiographs of all patients showed a radiolucent stripe that disappeared 7.3 +/- 1.5 (mean +/- SD) months after surgery. In the autograft group, a radiolucent stripe around the graft was not seen for any patient, and union was confirmed by follow-up radiographs within 6 mo after surgery. The serial changes in the 99mTc-HMDP uptake ratio showed no difference between the 2 groups. The 99mTc-HMDP uptake ratio peaked 1 mo after surgery and decreased rapidly to a plateau within 2 mo. CONCLUSION: In the HA graft group, despite the presence of a radiolucent stripe around the graft for more than 6 mo, the scintigraphic course of union was not different from that in the autograft group. The likelihood is that the presence of a radiolucent stripe around the HA graft in the early months after surgery is not always a sign of pseudoarthrosis.     

Problems and prospects for combined chemotherapy with 5-fluorouracil and low-dose cisplatin]

Recently, the efficacy of combined chemotherapy with 5-fluorouracil and low-dose cisplatin for advanced gastrointestinal cancer has been reported in Japan. However, this method has not become established, because the underlying logic is unclear and the quality of its clinical trials has been unsatisfactory. We suggest the mechanism for this depends not only on the action of CDDP as a modulator of 5-FU, but also on a mutual biochemical modulation in which 5-FU acts as a modulator of CDDP and enhances the effect of CDDP. We expect that numerous phase II studies and the accumulation of reliable data will lead to improvements.     

Case report: periodical infliximab administration enabled closure of colostomy in fistulating perianal Crohn's disease]

A 29-year old woman with Crohn's disease was performed colostomy due to severe perianal abscess. Her disease had been easy to recur and she was admitted to hospital for intestinal bleeding caused by acute exacerbation in Crohn's disease on October 2006. The bleeding was stopped rapidly and clinical remission was maintained with bimonthly administration of infliximab. Finally, her colostomy was closed after 5 years 8 months. Periodical treatment of infliximab not only prevented recurrence but also enabled closure of colostomy in fistulating perianal Crohn's disease.     

Habitual mandibular dislocation in two patients with Parkinson's disease]

There have been few case reports of mandibular dislocation in Parkinson's disease (PD) so far. We experienced habitual mandibular dislocation in two PD patients. They were a 74-year-old woman and a 56-year-old man, who were both graded V by Hoehn and Yahr's staging and had a 13- and 14-year history of PD, respectively. Remarkable retroflexion and rigidity of the neck was observed in both patients. Anterior dislocation of the jaw occurred without any special cause. Once the jaw was dislocated, it required unexpected power to reduce the dislocation against the rigidity. In a case of postencephalitic parkinsonism, continuous parkinsonian tremors of the mandible over a long period was indicated as a cause of the recurrent dislocation seen in the patient. No mandibular tremor, however, was observed in the present cases. The common feature of our two patients was retroflexion of the neck, which was assumed to make the suprahyoid muscles stretched and the mouth opened widely, causing the recurrent mandibular dislocation. Since the recurrence was prevented by chin cap, early chin cap therapy for the mandibular dislocation in parkinsonian patients is recommended.     

Analysis of the intraoperative shunt flow and its effect on late prognosis after Blalock-Taussig shunt in single ventricle

Single ventricle (SV) seems to likely to develop congestive heart failure after Blalock-Taussig shunt (BT), particularly when the regurgitation of atrioventricular valve (AVVR) is combined. Analysis of the relation between operative result and intraoperative BT shunt flow is made in order to draw a safety limit or shunt flow in SV. Twenty-six patients (pts) with SV who underwent BT had shunt flow measurement at surgery, 20 pts showed right ventricular (RV) type of SV, 5 had left ventricular (LV) type, and 1 undivided type. The common atrioventricular valve was associated in 19 patients. The age at operation ranged from 6 days to 14 years of mean 3.2 years and the flow ranged from 6 to 146 of mean 49 ml/min/kg. Seven developed congestive heart failure at late follow-up with 4 late deaths. The average flow in this group (poor result) was 68 +/- 40 (mean +/- SD) ml/min/kg, and the remaining pts with favorable results (n = 16) had a mean flow of 41 +/- 22 ml/min/kg (p less than 0.05). In the group of LV type (n = 5), there was one late death caused from apparently excessive shunt flow (146 ml/min/kg). In the group of RV type without AVVR (n = 10), three pts of poor result had flow over 50 ml/min/kg. In those with AVVR (n = 8), pts with poor result were found with flow below 50 ml/min/kg.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of cardiac amyloidosis showing the ischemic change by exercise Tl-201 myocardial scintigraphy

A case of cardiac amyloidosis, which was recognized as an ischemic change by exercise Tl-201 myocardial scintigraphy, was studied. The case was 41 year-old woman, whose initial symptom was pretibial edema and died of ventricular fibrillation. Ischemic change was ascertained by the treadmill exercise test and exercise Tl-201 myocardial scintigraphy, however, the significant coronary stenotic lesion was not detected by coronary angiography. Our data suggested that ischemic change may be related with the disturbance of microcirculation caused by deposit of amyloid in the vessels and/or around the vessels from the pathological findings.     

RETROSPECTIVE STUDY OF ENDOSCOPIC FINDINGS: 250 CASES OF GASTRIC CANCER

Background : The accuracy of endoscopy for detecting gastric cancer is high but failures may occur if the cancer is not visualized or recognized with gastroscopy. The aim of this study was to understand the reasons why gastroscopy may not detect gastric cancer. Methods : Patients with gastric cancer (n = 4053) diagnosed between 1979 and 1996 were studied by linking gastroscopic examinations (n = 111 094). Endoscopic records were reviewed in 250 patients who were diagnosed with gastric cancer but had not been diagnosed as such on the examination within the previous 3 years. Results : In 33 patients (13.2%) gastric cancer was detected at the advanced stage. The percentage of advanced cancer was significantly higher on the cardia and the gastric body than it was on the angulus and the antrum. In 107 patients (42.8%) no lesion was identified after reviewing endoscopic records. In 102 patients (40.8%) marked lesions were present but had not been diagnosed as such. In 41 patients (16.4%) gastric cancer may have been overlooked but due to a lack of photographic documentation in the specific areas, these findings were not confirmed. The percentage of the indeterminate examinations was significantly higher in lesions on the remnant stomach and the cardia than in other areas. Conclusion : In order to reduce the proportion of the advanced gastric cancer to under 20%, repeated endoscopic examinations were recommended within 2 years even if any suspicious lesions could not be detected by the initial examination.     

Respiratory pathophysiology during sleep in patients with myotonic dystrophy

Myotonic dystrophy is a genetic disorder inherited as an autosomal dominant trait. It is known to be associated with endocrine dysfunction, polar cataracts, cardiac abnormalities and other conditions. Respiratory distress constituents the principal problem in myotonic dystrophy. The author investigated postural change of respiratory function in 12 patients with myotonic dystrophy (MYD), and 7 patients with limb-girdle dystrophy (LG) and overnight polysomnography was performed on 10 patients with MYD and 5 patients with LG. The respiratory function in seated posture showed no significant difference between LG and MYD, but in patients with MYD, the vital capacity and the expiratory reserve volume in a supine posture was reduced in comparison to that during seated posture. However, the respiratory function in patients with LG was not significantly different in seated and supine postures. Also, in patients with MYD, there was a significant decrease in arterial PO2 from the seated posture to the supine posture, without a significant change in the arterial PCO2. However, in patients with LG, there was no significant change in arterial blood gas analysis parameters. It was speculated that these findings concerning respiratory function and blood gas analysis in patients with MYD were caused by the involvement of the diaphragm. In the supine posture, the diaphragm shifted to the cranial position because of the abdominal contents rising into thorax, therefore the lung volume was reduced and the ventilation-perfusion ratio deteriorated. The changes of respiratory function parameters and PaO2 were partly responsible for the hypoxemia observed during sleep in patients with MYD. Overnight polysomnography showed that 9 of the 10 patients with MYD and 1 of the 5 patients with LG presented apneas during sleep, particularly during REM, stage 1 and stage 2. Almost all apneas were central type, with a low percentage of obstructive apneas and the apnea index was 19.0/h (mean) in MYD, 6.5/h in one case of LG. These result strongly suggest that sleep apnea is of central origin, but the distinction between a central and an obstructive etiology is difficult in neuromuscular disease and particularly when a disorder of central ventilatory responsiveness is suspected. The respiratory function of MYD and LG in seated and supine postures was studied and overnight polysomnography performed. It was emphasized that it was important for the respiratory care of neuromuscular disease to consider the influence of postural changes in the respiratory function. The present series of studies revealed central sleep apnea in the patients with myotonic dystrophy.(ABSTRACT TRUNCATED AT 400 WORDS)     

Operant self-control procedure in modifying type A behavior

A multiple-baseline across subjects design was used to evaluate the effects of operant self-control procedure on altering speed/impatient behaviors of the Type A behavior pattern (TABP). The operant-self-control procedure consisted of self-monitoring, self-evaluation, and self-reinforcement. The results demonstrated empirically significant decreases in S/I behaviors of the TABP following transfer to the self-reinforcement condition. Significant reductions in the Jenkins Activity Survey and physical symptoms scores additionally evidenced the effects of the operant self-control procedure. The possibility of pathogenic factors of the TABP varying with culture, and the advantages of the operant self-control procedure are discussed.