Microcirculatory events in ischemia/reperfusion of the pancreas defined by continuous tissue oximetry

In ischemia/reperfusion of the pancreas impairment of microcirculation after reperfusion is believed to be of critical importance. The 'no-reflow' phenomenon is thought to cause persisting tissue ischemia, while the 'reflow-paradox' is defined as secondary impairment of nutritive perfusion. These phenomena have been shown by intravital microscopy but their effect on tissue oxygenation as assessed by continuous tissue oximetry has not been identified. In landrace pigs tissue oxygenation was investigated in warm ischemia/reperfusion of the pancreas by the use of continuous tissue oximetry. After reperfusion rapid reoxygenation occurred which was followed by a period of secondary hypoxia. Thereafter, secondary reoxygenation was found, and finally tertiary hypoxia with a gradual decline of tissue pO(2) was noted. The data show a relevant impairment of tissue oxygenation after reperfusion. However, 'no-reflow' seems not to be a primary failure of capillary reperfusion but the consequence of a short reperfusion period followed by secondary ischemia. The 'reflow-paradox' most likely corresponds to tertiary ischemia.     

Reward-dependent spatial selectivity of anticipatory activity in monkey caudate neurons.

Many neurons show anticipatory activity in learned tasks. This phenomenon appears to reflect the brain's ability to predict future events. However, what actually is predicted is unknown. Using a memory-guided saccade task, in which only one out of four directions was rewarded in each block of trials, we found that a group of neurons in the monkey caudate nucleus (CD) showed activity before presentation of an instruction cue stimulus. Among 329 CD neurons that were related to memory-guided saccade tasks, 156 showed the precue activity and 91 of them were examined fully. Remarkably, the magnitude of the precue activity varied across the four blocks of the one-direction-rewarded (1DR) condition, depending on which direction was rewarded. A majority of neurons with precue activity (83/91, 91%) showed significant directional preference. The best and worst directions were usually in the contralateral and ipsilateral directions, respectively. Within a block, the precue activity increased rapidly for the best direction in 1DR and decreased gradually for the worst direction in 1DR and all-directions-rewarded (ADR) condition. The precue activity was weak in ADR. The precue activity did not reflect the likelihood of a particular cue stimulus, because the probability of the cue appearing in each direction was the same regardless of the rewarded direction. These results suggest that each CD neuron indicates a particular position-reward association prospectively, usually with contralateral preference. Assuming that the CD neurons have access to saccadic motor outputs, the precue activity would create a motivational bias toward the contralateral space, even before an instruction is given by the cue stimulus.     

Cutaneous nerves in atopic dermatitis

Although pruritus is the cardinal symptom of atopic dermatitis, its mechanism is not well understood. Free nerve endings in the skin are involved in pruritus as itching receptors. We studied the cutaneous nerve fibres in lichenified lesions of 16 patients with adult atopic dermatitis. On immunohistochemistry, fibres immunoreactive for neurofilament, neuron-specific enolase, and protein gene product 9.5 were observed in the papillary dermis and dermoepidermal junctions as well as in the epidermis. In these areas, no fibres stained positively for substance P, neuropeptide Y, vasoactive intestinal peptide, beta endorphin, somatostatin or serotonin. On electron microscopy, the ultrastructure of subepidermal and intraepidermal free nerve endings appeared to be essentially normal. However, the distribution density of the cutaneous nerve fibres was much higher than in normal controls, and the diameter of these fibres was much larger, because of the large number of axons in each nerve fibre. Degranulation of mast cells was not seen. These findings suggest that pruritus in lichenified atopic skin is probably not caused by damage to the cutaneous free nerve endings. In such lesions, the number of the cutaneous free nerve endings is greatly increased, but they may have a normal function.     

Common and specific antigens of several treponemes detected by polyclonal antisera against major cellular proteins

Thirteen polypeptide antigens with molecular weights ranging from 34 kDa to 83 kDa were selected and their antigenic behaviors and distribution were examined in 12 strains of microorganisms including Treponema, Borrelia, Leptospira and Leptonema. Immunoblot analysis demonstrated that 45 kDa and 83 kDa polypeptides of Treponema socranskii subsp. buccale ATCC 35534, 53 kDa antigen of Treponema denticola ATCC 33520 and 44 kDa polypeptide of the strain G7201 were strain-specific. The 34, 62, 66 and 84 kDa polypeptide antigens were detected in all 8 treponemal strains examined. T. denticola ATCC 33520 and ATCC 35404 possessed 38 kDa, 48 kDa, 52 kDa and 72 kDa common polypeptide antigens. All 12 strains possessed the 84 kDa polypeptide antigen. Immunoelectron microscopy demonstrated that the 34 kDa and 38 kDa polypeptide antigens were located on the axial flagella and that other polypeptide antigens were located on the outer envelopes or wall-membrane complexes.     

Evaluation of an improved ileus monitoring system for intestinal motility

To observe the recovery of normal intestinal movement and the effects of peristalsis-promoting agents in patients with intestinal obstruction, an ileus monitoring system using the balloon method was simultaneously compared with that using the infusion method in 24 patients. To initiate the balloon ileus monitoring system, measurement was started at a setting of 0 after connecting a transducer to the balloon inflation channel of a decompression tube. The recording sensitivity was 20 mmHg/cm, and the speed of recording was 5 mm/min. The sensitivity of the infusion method was found to be 0.70±0.17 times that of the balloon method, and therefore the balloon method was considered to be more accurate. The findings of this study show how useful this ileus monitoring system is for observing the motility of intestinal obstruction.     

Paradoxic uptake of Gd-EOB-DTPA by hepatocellular carcinoma in mice: Quantitative image analysis

To determine whether paradoxic uptake of gadoliniumethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) occurs only with highly differentiated hepatocellular carcinomas, quantitative image analysis was performed in 37 mice with 133 hepatocellular carcinomas. The results of lesion/liver signal intensity measurement and relative enhancement calculation indicate that paradoxic positive enhancement occurs independently of cellular differentiation.     

Assessment of transendoscopic miniature ultrasonic probe for chemoradiotherapy outcome in patients with locally advanced esophageal cancer

Background: Assessment of the response of esophageal cancer to chemoradiotherapy is difficult. We investigated the value of a transendoscopic miniature ultrasonic probe (USP) in assessing response to chemoradiotherapy in patients with locally advanced esophageal cancer. Methods: A total of 33 patients were entered in this prospective study. Response to treatment was evaluated according to World Health Organization criteria. According to the sonographic image, complete response (CR) of the primary lesion was divided into two subcategories: confirmed CR (cCR) and unconfirmed CR (uCR). Results: Initial sonographic criteria for evaluating tumor depth and lymph nodes in the 33 patients before therapy showed two cases of T2N0, four of T3N0, 15 of T3N1, four of T4N0, and eight of T4N1. Following chemoradiotherapy, CR was obtained in 18 (54.5%): seven cCR and 11 uCR. Eleven were partial response (PR) (33.3%), while three were stable disease (SD) and one was progressive disease (PD). High frequency USP (20 MHz) was able to detect tumor disappearance and restoration of the esophageal wall. One‐year survival rates among CR (cCR + uCR), PR and SD + PD were 100%, 70% and 0%, respectively. A significant difference in survival was evident among CR, PR and SD + PD (P < 0.001). Three‐year survival rates between cCR and uCR were 100% and 40%, respectively. A significant difference in survival was evident between cCR and uCR (P < 0.001). In seven cases of uCR, local recurrence and distant metastasis appeared within 1 year, and five died of disease progression. Not one cCR case has relapsed. Conclusion: USP, which can be accomplished with a standard endoscopy, including biopsy, in one procedure, is a useful method for objectively assessing the response to chemoradiotherapy in patients with locally advanced esophageal cancer.     

Histopathological examination of in vitro bone degeneration caused by a black yeast, Exophiala spinifera.

Exophiala spinifera, a black yeast, rarely causes systemic infection, and only a very few cases of its infection by the invasion of internal organs or bones have been reported. We examined the ability of E. spinifera to invade bone tissues in vitro. The fungus was inoculated on the surface of murine bones, and then these bones were incubated at 30 C for 2, 4, and 12 weeks on water agar plates and on brain heart infusion agar supplemented with 1%glucose (BHIA) plates. Histopathological examination demonstrated that the fungus was initially found in the non-calcified parts of the bone tissue, such as the growth plate and articular cartilage. Thereafter, the fungus invaded the calcified parts: cancellous and cortical bones. Our experiments showed that the capability of E. spinifera to invade bone tissue is higher than that of Candida albicans or other black fungi. E. spinifera grew in the mycelial form and C. albicans in the yeast form in these experiments. Our results suggest that E. spinifera may have a high potential to invade bone tissues, and that the mycelial form can invade bone more deeply than the yeast form. Therefore, bone degeneration should/ must be carefully monitored in any systemic infection with E. spinifera.     

Studies on early stage changes of peroxide lipid in isoproterenol-induced myocardial injury]

The amount of peroxide lipid in vivo in the early stage of the experimental model of myocardial infarction in a rat induced by the administration of isoproterenol (Isp) was measured as the value of malonic dialdehyde (MDA). The model of myocardial infarction was made by giving 75 mg/kg of Isp to the rat weighing 270 +/- 10 g. After the administration of Isp, the amounts of lipid in the serum and in the myocardial tissue were measured, and a blood chemistry test (glutamic oxaloacetic dehydrogenase, glutamic pyruvic transaminase, lactate dehydrogenase, free fatty acid, creatine kinase) was simultaneously carried out on the serum. The value of the amount of peroxide lipid in the serum began to elevate 3 h after the administration of Isp and reached a maximum value at 6 h. The value of the amount of peroxide lipid in the tissue began to elevate 30 min after the administration and reached a maximum at 3 h. Each blood chemistry disclosed the elevation 30 min after the administration. As mentioned above, the production of peroxide lipid in vivo on the myocardial disorder in the early stage after the administration of Isp and the biochemical changes showed a significant correlation. From these results it is suggested that the myocardial disorder induced by the administration of Isp has already developed at 30 min after the administration.     

Care and problems in intractable neurological diseases--home care of intractable diseases from the view of a practicing physician]

Taking into account how to care patients at home with intractable neurological disease and their family, I have introduced the achievement of the medical caring technique by an aged family member, the risks of the PEG and acute respiratory failures under BiPAP, the problems in home rehabilitation, and the experiences of home terminal care, from the view point of a practicing physician. Home caring pursues to support patients and their family to live peacefully with disease with highest quality of life. Hospice caring is also an important issue. From now on, I would like to try to give even better home care by early recognition of problems and by cooperating with hospitals, clinics and other field workers.