Operative results of distal aortic arch aneurysms--approaching methods, bypass techniques and complications

Ten patients underwent repair of aneurysms of the distal aortic arch from 1985 to 1989. There were 8 men and 2 women: aged 58 to 77 (average age 67 years). Seven patients had sacciform aneurysms which were closed by graft patch aortoplasty, and three patients had fusiform aneurysms which were corrected by inserting tube grafts. Seven aneurysms operated since 1988 were approached through median sternotomy continued with left anterior thoracotomy, so called door open method. This approach presented good view of the diseased aorta, and effective for preventing recurrent and phrenic nerve palsy. We used temporary bypass for 4 patients, cardiopulmonary bypass for 4 patients (separate carotid artery perfusion for 2 patients) and centrifugal pump for 2 patients during aortic cross clamping. One patient died intraoperatively from intractable bleeding and two patients died postoperatively from brain damage due to embolic episodes during the operations. These patients showed the severely irregular intima in the aortic arch and were complicated with rupture of the aneurysm or dissections arising from the aneurysms. It should be noticed that careless manipulation of the aortic arch and the brachiocephalic vessels cause cerebral complications in such cases.     

Study on transfer of ceftriaxone into female genital organs

One gram of ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was given intravenously to a total of 25 patients prior to abdominal total hysterectomy for uterine myoma with or without small benign ovarian tumor. Bilateral uterine arteries were clamped at 0.5, 1, 2, 6, 12 and 24 hours after administration, and serum samples and uterine tissues were taken for the measurement of CTRX concentration by bioassay method. A little difference was found in the serum concentration between cubital venous and uterine arterial serum, the half-lives being 8.0 and 7.9 hours, respectively. The initial concentrations were estimated to be 153 micrograms/ml and 160 micrograms/ml, respectively. The tissue peak concentrations were obtained at 30 minutes in the myometrium, portio vaginalis, oviduct and ovary, and at 1 hour in the endometrium and cervix uteri. These were 41, 51, 51, 39, 42 and 47 micrograms/g, respectively. The tissue concentrations after peak decreased in the same manner as the serum concentrations. Judging from its favorable transfer into the uterine tissues, CTRX was evaluated to be clinically useful in the treatment of obstetrical and gynecological infections.     

Occupational therapy issues in the treatment of the long-term mentally ill.

In this paper, a single case study is used to facilitate discussion of problems encountered by occupational therapists engaged in working with the long-term mentally ill. The achievement of the long-range and multi-faceted approach necessary for the management of this population is a recognized challenge. Some of the paradoxes and dilemmas involved in programming and the measurement of outcome and success are clarified. As well, sources of stress to individuals involved in working with the long-term mentally ill are considered. Issues addressed include: philosophy of approach, professional and personal conflicts patients' wishes and involvement, and the low priority given to working with this group. Two main objectives of the paper are to: bring an appreciation for the complexity of the difficulties presented and demonstrate how occupational therapists can offer valuable contributions in working with the long-term mentally ill.     

Spinal lamina I neurons projecting to the parabrachial area of the cat midbrain

We have observed a population of lamina I neurons in the cat that has projections to the parabrachial area (parabrachial and cuneiform nuclei). A subpopulation of these neurons also projects to the contralateral thalamus. The majority of projecting cells responded exclusively to noxious stimuli, a few wide-dynamic-range neurons were also observed. Conduction velocities for antidromic activation from the midbrain ranged from 1 to 18 m/s. We stained 14 cells intracellularly with horseradish peroxidase. These findings suggest that a major nociceptive projection pathway originating in lamina I and terminating in the parabrachial area exists in the cat.     

Effects of fasting on distribution and excretion of lead following long-term lead exposure in rats

Lead was given to rats through drinking water containing 100 ppm lead acetate for 20 days. Delta-aminolevulinic acid dehydratase (ALAD) activity in erythrocytes was significantly lower (p < 0.05) at 20 days after Pb treatment. Erythrocytic ALAD activity was significantly lower (p < 0.05) in fasted rats than in fed rats with or without Pb pretreatment. Serum glutamic pyruvic transaminase and glutamic oxaloacetic transaminase activities after 6 days of fasting were significantly higher (p < 0.05) in Pb pretreated rats than in other groups (Ph nontreated fed and fasted rats, and Pb pretreated fed rats). Long periods of fasting strongly enhanced these serum-enzymes elevations induced by lead. Maximum Pb concentrations and total amount in feces increased in rats fasted for 3 days regardless of Pb pretreatment. On the other hand, total amount of Pb in feces of rats fasted for 6 days were not significantly different from the other groups because their fecal volume decreased to about 1 % of fed rats. The Pb concentrations of liver, kidney, spleen, and femur increased significantly in Pb pretreated rats compared to in controls, but there were no significant differences between the fed and fasted rats.     

Slow fluctuations of single unit activities of hippocampal and thalamic neurons in cats. II. Role of serotonin on the stability of neuronal activities

A series of experiments was carried out both in the hippocampal pyramidal and thalamic ventrobasal neurons to investigate the effect of serotonin level in the brain on slow fluctuations of neuronal discharges. Single neuronal activities were recorded in the following two pharmacologically treated states: (1) a 5-hydroxytryptamine depleted state by p-chlorophenylalanine administration (PCPA phase) and (2) a 5-methoxy-N,N-dimethyltryptamine administered state under the PCPA pretreatment (5-MeODMT phase). The slow fluctuations of neuronal activities in the frequency range of 0.02-1.0 Hz in both nuclei were prominent during the PCPA phase and were similar to those during the paradoxical sleep. In contrast, slow fluctuations were suppressed during the 5-MeODMT phase and neuronal activities during this phase were similar to those during slow wave sleep (SWS). The results show that serotonin in the brain definitely plays a role in stabilizing single neuronal activities.     

Successful surgery for an acute type A aortic dissection following repair of a descending thoracic aortic aneurysm

Acute type A aortic dissection in the presence of a previously repaired atherosclerotic descending thoracic aortic aneurysm is rarely reported. We experienced a patient who underwent an ascending aortic replacement with reconstruction of the aortic arch 16 months after repair of a descending thoracic aortic aneurysm. We succeeded in the redo operation with comprehensive techniques involving selective cerebral perfusion, deep hypothermia, early antegrade systemic circulation for cerebral protection, and femoro-femoral bypass with occlusion of the descending aorta for lower systemic perfusion as well as renal perfusion. The patient recovered and is doing well one year after the redo operation.     

Effects of extrinsic horizontal cell polarization on spike discharges in the carp retina

The effects of horizontal cell polarization on spike discharges were explored in superfused preparations of the carp retina. Light-induced discharge patterns of individual units were determined with spot and annulus stimuli of white light. The effects observed were classified in three response modes (common, reversed and transient). They were consistently observed as the tangential distance between the recording and current-injection electrodes was increased up to 400 μm. The common mode of response consisted of off-discharges upon depolarization and on-discharges upon hyperpolarization of horizontal cells. The reversed mode was opposite to the common. The transient mode consisted in transient spike discharges at the on- and off-sets of extrinsic currents injected into horizontal cells. The common mode of response was observed in 3 of 9 ON-center units, all of 20 OFF-center units and in 3 of 21 ON-OFF units. The reversed mode was seen in 6 of 9 ON-center units and in 4 of 21 ON-OFF units. The transient mode was only found in ON-OFF units. ON-center units can be divided into two subgroups: some responded with the common and others with the reversed mode. All OFF-center units showed exclusively the common mode. On the other hand, all 21 ON-OFF units showed the transient mode, but 9 exhibited one or two additional modes of response; 5 of them showed two (common and transient) modes and 4 showed all three modes, depending upon horizontal cells into which polarizing currents were injected.     

Changes of intracranial pressure during the rupture of intracranial aneurysms: Prognosis for survival

The intracranial pressure at the time of rebleeding from an intracranial aneurysm was recorded in 4 patients who were undergoing conservative treatment pending clinical improvement. Two died of severe hemorrhages and the remaining two recovered. In the deceased patients, repeated rapid increases in the intracranial pressure in a short time caused by rupture of the intracranial aneurysm were observed. In the surviving patients, the intracranial pressure increased only once, owing to the rupture of the intracranial aneurysm. We suggest that sudden death following the rupture of an intracranial aneurysm may result from frequent, repeated bleeding causing an intracerebral hematoma or severe brain swelling, or both.