The retention indices of 201Tl-SPECT in brain tumors

OBJECTIVE: The aim of this study was to assess the utility of 201Tl SPECT in the differential diagnosis of intracranial tumors and to determine the relationship between 201Tl uptake and histological types. METHODS: Thirty-eight patients (19 males and 19 females) with thirty-eight brain tumors were evaluated with 201Tl-SPECT. The early and delayed 201Tl uptake ratio was calculated, and the retention index (RI) was applied as follows; RI = delayed uptake ratio/early uptake ratio. RESULTS: The RI of malignant tumors was higher (0.72 +/- 0.18) than that of benign tumors (0.50 +/- 0.16) and the difference was statistically significant (p = 0.00045). The difference between high-grade glioma (0.80 +/- 0.15) and metastatic tumors (0.64 +/- 0.19) was statistically significant (p = 0.039). CONCLUSION: 201Tl-SPECT may add useful biochemical information and could differentiate malignant brain tumors from benign lesions, but the RI of metastatic tumors varied depending on the organs with the primary lesion and histological types.     

A novel method of 'preparative' myocardial protection using green tea polyphenol in oral uptake

Reperfusion injury has been one of the serious problems in cardiac surgery and medicine. We report a novel method of myocardial protection. Eight Sprague-Dawley rats, group A, were administrated green tea polyphenol orally. Eight other rats, group B, received no medication. Isolated hearts were perfused with a Langendorff's apparatus, and reperfused after 90min arrest. The left ventricular (LV) function, size, weight and the oxidative stress spaciotemporal analysis were performed. The LV size in group B became enlarged by 1.8+/-0.12 (mean+/-SD), but in group A, the LV enlarged only 1.1+/-0.08 times. The heart weight ratio was lighter (1.35+/-0.05) in group A than in group B (1.49+/-0.03, P<0.05). The LV end-systolic pressure volume relationship remained higher in group A. Oxidative stress as shown by 8-hydroxy-2'-deoxyguanosine was lower in group A (81.5+/-11.6) than in group B (226.9+/-35.6, P<0.0001). Polyphenol labeled FITC was located in the cell membrane of cardiomyocite. Polyphenol can protect a heart from oxidative stress, and maintain good LV function after ischemic arrest and reperfusion. This pre-treatment by polyphenol may add further benefit to current treatments of myocardial protection.     

Surgical statistics of the Department of Urology, Isesaki Municipal Hospital during a five-year period (June 1998-May 2003)

We reviewed the surgical statistics of the Department of Urology, Isesaki Municipal Hospital between June 1998 and May 2003. A total of 1940 surgeries were performed. These consisted of 399 surgeries on the kidney, adrenal, and pelvis, 212 on the ureter, 433 on the bladder, 256 on the prostate, 149 on the urethra and the penis, 192 on the scrotum, 255 on the arteriovenous fistula and CAPD. In September 2003, a screening program for prostate cancer was started, and the number of prostate biopsies and total prostatectomies increased. As the adaptation of many procedures to laparoscopy expanded, the number of laparoscopic surgeries increased.     

Imaging features of maxillary osteoblastoma and its malignant transformation

We report two cases of osteoblastoma, one of them an unusual case in a 32-year-old woman in whom a maxillary tumor was confidently diagnosed as an osteoblastoma at the time of primary excision and subsequently transformed into an osteosarcoma 7 years after the onset of clinical symptoms. The other patient developed osteosarcoma arising in the maxilla, which was diagnosed 3 years after the primary excision and is very suggestive of malignant transformation in osteoblastoma. We present the radiological features, including computed tomographic and magnetic resonance imaging studies, of this unusual event of transformed tumor and compare imaging features of benign and dedifferentiated counterparts of this rare tumor complex.Members of the Group for the Image Diagnosis of Craniofacial Disorders     

Role of luminal Ca2+ on normal and damaged gastric mucosa in the rat

Influence of luminal Ca²⁺ on the integrity of normal mucosa and recovery of damaged mucosa in anesthetized rat stomachs was studied using a perfusion system. Changes in the mucosal integrity were monitored by measuring transmucosal potential difference (PD) and luminal pH. EDTA, a Ca²⁺ chelator, dose-dependently reduced PD and increased luminal pH. Five mM Ca²⁺ (CaCl₂) alone produced no changes in either PD and luminal pH, but the PD which was reduced by 250 mM EDTA was significantly recovered. Ethanol or NaCl concentration-dependently reduced PD, but gradually reverted to baseline levels. While 5 mM Ca²⁺ or 5 mM EDTA did not influence the reduction in PD with 50% ethanol or 1 M NaCl, these agents either enhanced or delayed the recovery processes in reduced PD, respectively. Five mM Ca²⁺ enhanced the recovery of PD which was reduced by 50% ethanol plus 5 mM EDTA. Gastric damage induced by 50% ethanol plus 5 mM EDTA was much more severe than that induced by 50% ethanol alone or 50% ethanol plus 5 mM Ca²⁺. Both 50% ethanol and 1 M NaCl significantly increased Ca²⁺ contents in the gastric lumen. Luminal Ca²⁺ appears to play an important role in maintaining mucosal integrity, under normal physiological conditions, and in accelerating the recovery process of damaged mucosa in rat stomachs.     

Periurethral injection of autologous adipose‐derived regenerative cells for the treatment of male stress urinary incontinence: Report of three initial cases

Objectives: To report a novel cell therapy using autologous adipose tissue‐derived regenerative cells for male stress urinary incontinence caused by urethral sphincteric deficiency, and the outcomes in the initial cases undergoing periurethral injection of adipose tissue‐derived regenerative cells. Methods: Three patients with moderate stress incontinence after radical prostatectomy and holmium laser enucleation of the prostate were enrolled. Adipose tissue‐derived regenerative cells were isolated from the abdominal adipose tissue by using the Celution system. Subsequently, the isolated adipose tissue‐derived regenerative cells, and a mixture of adipose tissue‐derived regenerative cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Short‐term outcomes during a 6‐month follow up were assessed by a 24‐h pad test, a validated patient questionnaire, urethral pressure profile, transrectal ultrasonography and magnetic resonance imaging. Results: Urinary incontinence progressively improved after 2 weeks of injection up to 6 months in terms of decreased leakage volume, decreased frequency and amount of incontinence, and improved quality of life. Both maximum urethral closing pressure and functional profile length increased. Magnetic resonance imaging suggested a sustained presence of the injected adipose tissue. Enhanced ultrasonography showed a progressive increase in the blood flow to the injected area. No significant adverse events were observed peri‐ and postoperatively. Conclusion: These preliminary findings suggest that periurethral injection of the autologous adipose tissue‐derived regenerative cells is a safe and feasible treatment modality for male stress urinary incontinence.     

Hepatic resection using a liver-hanging maneuver and Glissonean pedicle transection for hepatocellular carcinoma in a patient with situs inversus totalis: report of a case

Situs inversus totalis is a rare congenital anomaly in which the major abdominal organs are located as a mirror image of their normal positions. This poses much difficulty for surgeons. We describe how we performed the liver-hanging maneuver (LHM) for hepatocellular carcinoma (HCC) in a 59-year-old man with situs inversus totalis, to resolve the difficulty of the mirror-image location of his liver. The HCC was located in the right lateral sector. Although segmentectomy of segment 7 would normally be considered minimal for a curative treatment of HCC, this was relatively complicated in this patient. Thus, we performed an extended right lateral sectionectomy using the LHM to achieve a simple transection. The hepatic hilum was dissected using the Glissonean pedicle transection method. The operation time and intraoperative blood loss were 6 h 45 min and 471 ml, respectively. No blood product transfusion was required. The LHM and the hilar Glissonean pedicle approach proved effective for resolving the difficulties of performing surgery in a mirror image for HCC in a patient with situs inversus totalis.     

Axilloaxillary bypass for the treatment of subclavian artery stenosis complicated by bilateral common carotid artery occlusion: technical case report

OBJECTIVE AND IMPORTANCE: We successfully treated a patient with stenosis of the left subclavian artery, complicated by bilateral common carotid artery occlusion, via axilloaxillary bypass surgery. CLINICAL PRESENTATION: A 67-year-old patient with a history of hypertension and cerebral infarction underwent neck irradiation for treatment of a vocal cord tumor. Three months later, he began to experience transient tetraparesis several times per day. The blood pressure measurements for his right and left arms were different. Supratentorial blood flow was markedly low. The common carotid arteries were bilaterally occluded, and the right vertebral artery was hypoplastic. Therefore, only the left vertebral artery contributed to the patient's cerebral circulation; his left subclavian artery was severely stenotic. INTERVENTION: The patient underwent axilloaxillary bypass surgery because the procedure avoids thoracotomy or sternotomy, manipulation of the carotid artery, and interruption of the vertebral artery blood flow. The patient has been free of symptoms for more than 5 years. CONCLUSION: Neurosurgeons should be aware that extra-anatomic bypass surgery is an effective treatment option for selected patients with cerebral ischemia.     

Effects of barium concentration on the radiopacity and biomechanics of bone cement: experimental study

Purpose  This study was undertaken to evaluate the changes in the radiopacity and mechanics of polymethylmethacrylate (PMMA) bone cement with the addition of barium. Materials and methods  Barium sulfate powder was added to a PMMA bone cement with an initial 10% barium concentration. The changes in radiopacity and strength were evaluated by testing cement blocks containing four barium concentrations (10%, 20%, 30%, 40%). Radiopacity was evaluated by measuring the computed tomography (CT) values of the bone cement, and strength was evaluated by compressive, three-point bending, and impact load tests. Results  CT values increased in proportion to the barium concentration. The compressive load test showed that cement with a 40% barium concentration was significantly more fragile than cement with lower barium concentrations. The three-point bending load test showed that the cement became more fragile in proportion to the barium concentration. The impact load test showed that cement with 30% and 40% barium concentrations was significantly more fragile than cement with 10% and 20% barium concentrations. Conclusion  Radiopacity is increased and strength is reduced by adding increasing concentrations of barium powder to bone cement. The results of the present study suggest that adding barium permits the radiopacity and strength of bone cement to be adjusted in clinical practice.