An Operating Microscope with Higher Magnification and Higher Resolution for Cerebral Aneurysm Surgery: Preliminary Experience—Technical Note

We describe a higher magnifying power operating microscope system to improve one method of high-quality microsurgical clipping for cerebral aneurysm in some cases. This higher magnification is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnifications (distinctiveness of 7 μm). This higher-resolution operating microscope system provides the surgeon with higher-magnified images (at the maximum of more than 30× magnifications as each working distance) in the operating field. The magnifications can be changed from low power (2.9×) to high power (62.0×) depending on the circumstances in a given procedure. We have used this operating microscope system on 11 patients with microsurgical clipping for cerebral aneurysms. Microsurgical treatment could be performed safely and precisely. All aneurysms were treated without any technical complications. We think that the use of this microscope would have potential benefits for microsurgical treatment for cerebral aneurysms because of better visualization.     

肉豆蔻酸异丙酯对酮基布洛芬经皮渗透的影响

目的 评价皮肤角质层和真皮层对药物经皮渗透的影响。方法 选择酮基布洛芬为模型药物，采用Franz扩散池法，考察药物经完整皮肤和剥离角质层皮肤的体外表现透皮系数Kp，并比较吸收促进剂肉豆蔻酸异丙酯（IPM）共存进的促透差异。结果 酮基布洛芬经剥离角质层皮肤的Kp是完整皮肤的1.7倍，IPM能分布在真皮层并可明显增加药物在角质层的分布和经皮累积渗透量。结论 本实验为皮肤病态条件，如皮肤受伤或溃疡等时药物经皮吸收规律研究提供一种新的方法。     

TWO AUTOPSY CASES OF CONGENITAL HYDRONEPHROSIS DUE TO URETERAL OBSTRUCTION

Two autopsy cases of congenital hydronephrosis are reported, and a short comment was made concerning its pathogenesis.
One was unilateral and caused by membranous obstruction at the ureterovesical junction, and the other was bilateral and due to fibrous, cord-like change of both ureters about 1–2 cm below the ureteropelvic junction. Comparative studies were made between our two cases and with cases which had been published so far in Japan and in some other countries. ACTA PATH. JAP. 20: 207–213, 1970.     

Importance of mechanical damage to urinary red blood cells by the glomerular basement membrane

The reasons for morphological changes of urinary red blood cells (RBC) in patients with glomerulonephritis are still controversial. In order to evaluate the importance of mechanical damage by the glomerular basement membrane (GBM), we examined urinary RBC taken from the patients with two different diseases which have characteristic GBM changes. Urinary RBC taken from 20 patients with Alport syndrome and nine with thin GBM disease were examined using a scanning electron microscope. Nineteen out of the 20 patients (95.0%) with Alport syndrome showed ‘glomerular type’, while five of the nine patients (55.6%) with thin GBM disease showed ‘glomerular type’. These results suggest that more complicated GBM abnormalities cause more severe RBC distortion. Therefore, we conclude that mechanical damage by the GBM may be the major factor in dysmorphism of urinary RBC.     

Transcatheter Arterial Embolization for Spontaneous Rupture of Hepatocellular Carcinoma

For the last 6 yr, we had 47 cases of spontaneous rupture of hepatocellular carcinoma causing hemorrhage into the peritoneal cavity. Thirty-three cases were treated by supportive care and 14 cases by emergency transcatheter arterial embolization. Fourteen cases underwent emergency transcatheter arterial embolization and abdominal pain developed in 71.4%, shock in 50.0% and bloody ascites in all cases and the hematocrit of bloody ascites ranged between 1.0% and 40%. On hepatic angiogram, the mean tumor extent rate was 47.9% and the extravasation of the contrast material was noted in 35.7%. The mean survival time of 14 cases that underwent emergency transcatheter arterial embolization was 98.5 days and 13.0 days in 33 cases with supportive care. The former was significantly longer than the latter.     

Multifocal metastases of recurrent renal cell carcinoma successfully treated with a combination of low dose interleukin-2, α-interferon and radiotherapy

A 59-year-old man presented with a 2-month history of left flank pain and a possibility of gross hematuria. Left renal cell carcinoma stage II was diagnosed and radical left nephrectomy was performed. Twenty-two months postoperatively, lung metastases were demonstrated and 6 x 10(6) units of alpha-interferon (IFN-alpha) were administered for 9 months, only to keep the sizes of the metastases unchanged. Thirty-four months after the operation, liver metastases and bone metastasis in the left sacroiliac joint were revealed. The combination cytokine therapy was performed with 1.4 x 10(6) U of interleukin-2 (IL-2) and 3 x 10(6) U of IFN-alpha for 16 weeks, and the left sacroiliac joint metastasis was treated with radiation therapy of 4 Gy per day for 7 days. Six months after the 16 weeks of immunotherapy, computed tomography and bone scintigraphy revealed that the metastases of the lung, liver and bone substantially disappeared and this complete response is still kept after 16 months.     

Discrepancy between Preoperative Imaging and Postoperative Pathological Finding of Ruptured Intracranial Dissecting Aneurysm,and Its Surgical Treatment: Case Report

The choice of therapeutic strategy for intracranial dissecting aneurysm is often based on radiographic features, including characteristic geometry (e.g., irregular stenosis, segmental stenosis, aneurysm formation [pearl-and-string sign]), irregular fusiform or aneurysmal dilation, double lumen, and tapering occlusion. However, there is often a discrepancy between preoperative radiographic data and actual dissecting length. The present report describes three cases in which there was a discrepancy between preoperative radiographic data and actual dissecting length in patients undergoing direct trapping with or without revascularization. All three cases experienced good outcomes, but these cases underscore the fact that open surgery is a good option for management of ruptured intracranial dissecting aneurysms for determination of the rupture point, dissecting length, and the relationship between dissecting area and small arteries arising from the associated vessel.     

Usefulness of V3-Radial Artery Graft-V4 Bypass in Bilateral Fusiform Aneurysms of Vertebral Artery: Case Report

A 55-year-old woman with bilateral vertebral artery (VA) aneurysms was transferred to our hospital. She suffered from a minor stroke. Magnetic resonance imaging (MRI) for the stroke incidentally revealed bilateral VA aneurysms. Due to its size, more observation was recommended, and the patient was found eager to be treated. Both side surgeries were found inappropriate because of severe lower cranial nerve disturbances. The right aneurysm involved the posterior inferior cerebellar artery (PICA) and the V4 segment was deviated to the right side. Therefore, the smaller right aneurysm was treated first with an occipital artery (OA)-PICA bypass and a V3-radial artery graft (RAG)-V4 bypass followed by proximal clipping of the PICA and the right VA. The right VA was successfully remade by RAG and the right aneurysm was not revealed on postoperative examination. By doing so, the opposite aneurysm was able to be eliminated by the parent artery occlusion even by using an interventional radiology (IVR). The V3-RAG-V4 bypass is a useful method for treating bilateral VA aneurysms. This is a new bypass which has not been reported so far to the best of our knowledge.     

The peritoneal equilibration test variables in pediatric CAPD patients

The peritoneal equilibration test (PET) is generally accepted as a valuable tool in individualizing continuous ambulatory peritoneal dialysis (CAPD) treatment schedules in adults. However, the classification of peritoneal permeability as described by Twardowski is not available for children due to differences in peritoneal transport abilities. In this paper, we report the results of the PET for 20 patients aged from 1.5 to 24 years (mean 10.3 years), who started CAPD therapy at age 0–15 years, using Twardowski's standardized technique. D/P creatinine (dialysate to plasma ratio of creatinine at 4 h), D/D₀ glucose (the ratio of dialysate glucose at 4 h dwell time to dialysate glucose at 0 dwell time), and the residual volume (RV) in the abdominal cavity were calculated. The mean and standard deviation values for D/P creatinine and D/D₀ glucose were of a higher permeability level than those reported in Twardowski's data. Furthermore, a significant correlation of creatinine and glucose with fluid drainage ability of the peritoneum were observed. A large amount of RV (425±125 mL/m²) was detected in the patients' peritoneal cavity and this had a significant correlation with dialysate leak occurrences. The authors suggest that the RV would be an indicator for leaks and especially latent leaks. The cause of a large RV is unknown, but there is a probability that drainage volume and transport rates of metabolites decrease because the concentration of the instilled dialysate is immediately diluted by a large RV within the peritoneum.