Evaluation of circulatory compromise in the leg in lumbar spinal canal stenosis

To evaluate whether hemoglobin oxygen saturation and hemoglobin concentration of the leg are useful indicators for circulatory compromise in patients with lumbar spinal canal stenosis, we investigated the changes in the indices during level gait using reflectance spectrophotometry. Thirty-three patients with lumbar spinal stenosis were studied. Preoperatively, the hemoglobin oxygen saturation was greater in the 33 patients than in the control subjects. The indices increased in the control subjects more than those in the patients. Postoperatively, the increases in hemoglobin oxygen saturation were greater in the patients with lumbar spinal canal stenosis than before decompression and the hemoglobin concentration tended to approximate that in the control subjects. The results suggest these indices might be useful for monitoring disease severity in patients with lumber spinal canal stenosis. In addition to stenotic ischemia in the spinal canal, it is thought that the neurogenic intermittent claudication is secondarily caused by circulatory failure in the lower extremities attributable to the autonomic nervous dysfunction.     

Nutritional implications of high-iodine egg diet in rats: effects on lipid metabolism and thyroid function

The effects of a diet including high-iodine eggs, containing much higher amounts of iodine than ordinary eggs, were investigated on lipid metabolism and thyroid function in rats. To a non-purified diet was added at the 1% (w/w) level ordinary egg power (OE diet: 35 micrograms iodine/100 g diet) or high-iodine egg powder (IE diet: 392 micrograms iodine/100 g diet). At 7 months and 19 months, feeding of the IE diet resulted in a lowered serum triacylglycerol level, elevated tissue lipoprotein lipase activity and a lowered lipid peroxide level in the brain. Although the serum total iodine level was 5 times higher in animals given the IE diet than in those given the OE diet, serum levels of thyroid-related hormones (TSH, T3 and T4) were not affected by feeding of the IE diet. In animals exposed to cold and given antithyroid drug treatment, the IE diet seemed to improve age-related defects in thermogenic and thyroid hormone responses to cold, and also to confer resistance to the antithyroid drug. These results suggest that iodine ingestion through high-iodine eggs modulates both lipid metabolism and thyroid function in rats.     

Echocardiographic assessment of mitral annular calcification in hypertrophic cardiomyopathy with asymmetric septal hypertrophy and healthy elderly cases

The prevalence and degree of mitral annular calcification (MAC) in elderly cases of hypertrophic cardiomyopathy with asymmetric septal hypertrophy (ASHCM) were studied in comparison with healthy elderly and chronic hypertensive elderly with concentric left ventricular hypertrophy (HT + LVH) by echocardiography. In seven elderly patients with ASHCM (mean age 77.3 +/- 8.1 years) severe MAC was observed in all cases (1 male and 6 females) and systolic anterior motion of the mitral valve (SAM) was present in 3 cases, incomplete in 2 and absent in 2 cases. Of 57 healthy elderly with a mean age of 78.8 +/- 8.8 years, 8 subjects (1 male and 7 females, 14%) showed MAC. The prevalence of MAC was 0% in the sixties, 14% in the seventies, 16% in the eighties and 29% in the nineties. MAC was severe in four subjects above eighty years old. In 3 cases with HT + LVH with a mean age of 72.3 +/- 4.7 years no MAC was observed and SAM was present in one, partially observed in one and absent in one case, respectively. Serum calcium (Ca) and phosphorus (P), reported to be related with the formation of MAC, and fasting blood sugar level (FBS) were evaluated. In healthy elderly with MAC, serum Ca was 8.78 +/- 0.46 mg/dl, P 3.55 +/- 0.37 mg/dl and FBS 97.75 +/- 29.01 mg/dl, P 3.55 +/- 0.37 mg/dl and FBS 97.75 +/- 29.01 mg/dl.(ABSTRACT TRUNCATED AT 250 WORDS)     

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Surgical Endoscopy -     

Regulation of ER molecular chaperone prevents bone loss in a murine model for osteoporosis

Endoplasmic reticulum (ER) stress response is important for protein maturation in the ER. Some murine models for bone diseases have provided significant insight into the possibility that pathogenesis of osteoporosis is related to ER stress response of osteoblasts. We examined a possible correlation between osteoporosis and ER stress response. Bone specimens from 8 osteoporosis patients and 8 disease-controls were used for immunohistochemical analysis. We found that ER molecular chaperones, such as BiP (immunoglobulin heavy-chain binding protein) and PDI (protein-disulfide isomerase) are down-regulated in osteoblasts from osteoporosis patients. Based on this result, we hypothesized that up-regulation of ER molecular chaperones in osteoblasts could restore decreased bone formation in osteoporosis. Therefore, we investigated whether treatment of murine model for osteoporosis with BIX (BiP inducer X), selective inducer BiP, could prevent bone loss. We found that oral administration of BIX effectively improves decline in bone formation through the activation of folding and secretion of bone matrix proteins. Considering these results together, BIX may be a potential therapeutic agent for the prevention of bone loss in osteoporosis patients.     

RGS16 Is a Marker for Prognosis in Colorectal Cancer

Background  

The RGS family, comprising 22 homologues of proteins, plays a role in cellular proliferation, differentiation, membrane trafficking, and embryonic development through the involvement of the mitogen-activated protein kinase signaling pathway.     

Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan

Purpose  The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists’ fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians’ stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. Methods  A questionnaire survey was performed targeting 1010 members of the Japanese Society of Anesthesiologists working as anesthesiologists affiliated with acute care hospitals in Japan. Data on background information, working environment, operation anesthesia duties, and stress were collected, and the relationship of work stress with background, environment, and anesthesia duties was evaluated by linear regression analysis. Results  Responses were obtained from 383 full-time anesthesiologists (response rate, 43.9%). The total anesthesia time per week was 23.6 h on average. The work stress score was 114.3 ± 30.2 (mean ± SD) when the average workers’ work stress score in Japan was 100. The work stress score was significantly associated with “years of experience” (with experience < 10 years considered as the reference; 10–19 years: β = −0.18, P = 0.02, ≥20 years: β = −0.15, P = 0.04), “hospital with ≥500 beds” (with a hospital with ≤ 299 beds considered as the reference; β = 0.15, P = 0.04), “total time of anesthesia per week” (β = 0.18, P.02), “estimated annual cases managed by an anesthesiologist” (β = 0.12, P = 0.04) and “no-support stress” (β = 0.21, P < 0.01) on linear regression analysis (R² = 0.12). Conclusion  Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors. Summaries of this study were presented at the 53rd and 54th General Meetings of the Japanese Society of Anesthesiologists (JSA) at Kobe (2006) and Sapporo (2007).     

Two cases of curative resection for locally recurrent rectal cancer with high-level sacrectomy after preoperative chemoradiation therapy (CRT)

We herein report two cases of locally recurrent rectal cancer that were successfully treated by surgical resection of shrunken tumor by pre-operative CRT. Although one case had a relapse in 7 months after the operation, the prognostic difference between two cases was discussed. CASE 1: A 54-year-old male had a pre-sacral mass (54 mm) six months after an anterior resection for advanced rectal cancer. We planned a surgical resection after CRT (radiation 50 Gy, CPT-11, UFT and LV). The tumor had a good response (33 mm) allowing a dissection area between sacral bone and posterior margin. Low anterior resections with sacral bone resection (below S3) were done to prevent S1 nerve roots injury and spinal fluid leakage. Macroscopically, a surgical margin was well secured. The patient is alive for 84 months after the surgery without an evidence of recurrence. CASE 2: A 66-year-old man had an anal bleeding. He underwent Hartmann's maneuver for advanced rectal cancer. MRI revealed a recurrent tumor (66 mm) occupying up to the 1st sacral bone. CRT was carried out. After a tumor response was (35 mm) obtained, and total pelvic exenteration with sacral bone resection below S3 was carried out, achieving R0 operation. However, He had relapsed at 7 months after the operation.     

Development of a compact laparoscope manipulator (P-arm)

Background

Laparoscope manipulating robots are useful for maintaining a stable view during a laparoscopic operation and as a substitute for the surgeon who controls the laparoscope. However, there are several problems to be solved. A large apparatus sometimes interferes with the surgeon. The setting and repositioning is awkward. Furthermore, the initial and maintenance costs are expensive. This study was designed to develop a new laparoscope manipulating robot to overcome those problems.

Methods

We developed a compact robot applicable for various types of laparoscopic surgery with less expensive materials. The robot was evaluated by performing an in vitro laparoscopic cholecystectomy using extracted swine organs. Then, the availability of the robot to various operations was validated by performing a laparoscopic cholecystectomy, anterior resection of the rectum, and distal gastrectomy using a living swine. The reliability of the system was tested by long-time continuous running.

Results

A compact and lightweight laparoscope manipulating robot by the name of P-arm was developed. The surgical time of an in vitro laparoscopic cholecystectomy with and without the P-arm was not different. The three types of operations were accomplished successfully. During the entire procedure, the P-arm worked without trouble and did not interfere with the surgeons. Continuous 8-h operating tests were performed three times and neither discontinuance nor trouble occurred with the system.

Conclusions

The P-arm worked steadily for various swine operations, without interfering with surgeon’s work.