Endoscopic anterior cruciate ligament reconstruction using a computer-assisted fluoroscopic navigation system

Background During anterior cruciate ligament (ACL) reconstruction, placement of the reconstructed ligament affects the clinical results. To accomplish accurate and reproducible placement of the tibial bone tunnel, we employed a fluoroscopic navigation system for endoscopic ACL reconstruction. In this study, preciseness of the tibial tunnel placement was evaluated, and the advantages and disadvantages of this navigation system for endoscopic ACL reconstruction are discussed. Methods Altogether, 16 knees of 16 patients who had undergone ACL reconstruction using this system (navi group) were evaluated regarding the positioning of the tibial tunnel against Blumensaat's line using X-p and the route of the graft by magnetic resonance imaging (MRI). Another 16 knees of 16 patients who underwent endoscopic ACL reconstruction without the navigation system were the controls (control group). Results At the 1-year follow-up, maximally extended lateral knee X-p revealed that the anterior edge of the tibial tunnel and Blumensaat's line were almost aligned and that roof impingement was avoided; the T2-weighted MR images showed that the graft was placed close to and parallel to the intercondylar roof in all the knees of the navi group. The ratio of the distance between Blumensaat's line and the anterior edge of the tibial tunnel at the level of the tibial plateau to the anteroposterior width in fully extended true lateral radiographs was 2.7% ± 3.4% in the navi group and 8.4% ± 7.4% in the control group. Conclusions The computer-assisted fluoroscopic navigation system improves accuracy and decreases dispersion of the tibial tunnel placement against Blumensaat's line in single-bundle ACL reconstruction. This innovative device renders the reconstruction procedure more reliable, eliminating the problem of skeletal variation among patients. However, the function of this navigation system for femoral tunnel placement is insufficient at present. Further refinement of the system is necessary, and the method of application requires improvement.     

Experimental studies on metastases from an irradiated tumor]

This study was carried out to determine the effect of irradiation of a tumor on the development of lung metastases. SANH, a spontaneous sarcoma, was isotransplanted in the right thighs of C3H mice which were either locally preirradiated (30 Gy: TBR) or non-irradiated. When the tumors had grown to 7 mm in diameter, they received 20-30 Gy of electron beams (RTx). The tumor-bearing legs were amputated at various tumor sizes, and the incidence of metastasis and number of lung nodules were compared in each treatment group. The incidences of metastases from 7 mm tumors in mice with regrowing tumors after RTx (30 Gy) and non-irradiated mice were 28% and 4%, respectively. When tumors grown in preirradiated legs were removed at 7 mm in diameter, the incidence of metastases (58%) was also enhanced by preirradiation of the tumor bed. Seven millimeter tumors that were growing in TBR legs and received RTx (20 Gy) developed a higher incidence (82%) and greater numbers of metastases than either the RTx or TBR groups. To determine the relationship between the interval of tumor bearing and development of metastases, tumors were removed at various intervals after tumor transplantation in 4 groups, namely, non-irradiated, TBR, RTx and TBR with 20 GyRTx. Lung metastases came later but increased steeply in mice given either TBR or RTx, compared with non-irradiated mice. Tumors growing in TBR and receiving RTx (20 Gy) developed many more metastases than any other group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Analysis of the determinant factors for open heart surgery without blood transfusion by the quantification theory--possibility of application of maximum surgical blood order schedule for open heart surgery]

In order to complete operations without blood transfusion we have chosen means of preoperative autologous blood saving and intraoperative autotransfusion, but we have not always achieved our purpose. We examined 29 patients (13 patients without blood transfusion and 16 with blood transfusion) to analyze the determinant factors as to whether open heart surgery without blood transfusion may be indicated or not, according to the quantification theory (type II) and to examine the possibility to apply the maximum surgical blood order schedule (MSBOS) for the open heart surgery by the quantification theory (type I). The analysis of determinant factors revealed hematocrit (Ht) value before saving of blood (more than 40%) as the best contributor of possibility of non-blood transfusion surgery, followed by the amount of blood loss during operation (less than 600 ml), the amount of saving blood (more than 800 ml), body weight (less than 70 kg), calculated Ht value on the beginning of cardiopulmonary bypass (CPB) (more than 24%), CPB time (less than 120 minutes) and the amount of postoperative blood loss (less than 600 ml). The prospective using blood volume at the operation was precisely calculated by the values of 4 preoperative factors, that is, the amount of saving blood, calculated Ht value on the beginning of CPB, CPB time and body weight. Therefore it is important to increase the amount of preoperative saving blood and decrease the amount of surgical bleeding in order to perform operations without blood transfusion, and is possible to apply the MSBOS for the open heart surgery.     

Foreign-body granuloma as a complication of wrapping and coating an intracranial aneurysm. Case report

A rare case is presented in which a foreign-body granuloma developed at the site of muslin wrapping and Aron Alpha A coating of an internal carotid artery aneurysm. The importance of avoiding the use of muslin, especially close to the optic nerve and chiasm, is emphasized.     

Epilepsy and Recursive Consciousness with Special Attention to Jackson's Theory of Consciousness

Summary: John Hughlings Jackson's theory of consciousness has been reconsidered. The author stressed that his uniqueness as a neuroscientist lay in his keen interest in the recursive nature of human consciousness. Two clinical symptoms of interest to Jackson were discussed: recurrent utterances and mental diplopia. Recurrent utterances were believed to represent an exceptional state, in which the unconscious process in speech production, otherwise destined to be swept away automatically, became manifest and observable. Jackson regarded mental diplopia as a revelation of otherwise inaccessible duality of all healthy mental actions. Therefore, he supposed that the essence of recursive consciousness resided in a transformation of multiple, multidirectional, unconscious processes into a linear, unidirectional process     

Effects of suramin on metastatic ability,proliferation, and production of urokinase-type plasminogen activator and plasminogen activator inhibitor type 2 in human renal cell carcinoma cell line SN12C-PM6

Effects of suramin, a polysulfonated naphthylurea compound, on metastatic ability, proliferation, and production of plasminogen activators and plasminogen activator inhibitors were studied using the highly metastatic human renal cell carcinoma cell line, SN12C-PM6. After renal subscapular implantation of tumor cells in nude mice, suramin significantly inhibited metastasis of tumor cells to the lungs and liver. In vitro growth of tumour cells was inhibited by suramin in a dose-dependent manner, at relatively low doses (ID₅₀ = 105 µg/ml). Plasminogen activator inhibitor type 2 (PAI-2) production by tumor cells was enhanced by suramin (100 µg/ml), whereas urokinase-type plasminogen activator (uPA) production was suppressed. Thus, the increase in PAI-2 and the decrease in uPA production correlated with the inhibitory effects on tumour growth and metastasis by suramin. Therefore suramin may be beneficial for the treatment of patients with an early stage of renal cancer with potential risk of metastasis.     

Effects of post‐inhalation treatment with interleukin‐12 on airway hyper‐reactivity, eosinophilia and interleukin‐18 receptor expression in a mouse model of asthma

BACKGROUND: Correcting Th1/Th2 imbalance with administration of IL-12 before and during antigen challenge holds therapeutic promise in asthma. However, the effects of IL-12 on the established asthmatic responses have not fully been examined. OBJECTIVE: We investigated whether IL-12 administered after antigen challenge could diminish airway hyper-reactivity (AHR) and eosinophilia in mice actively sensitized to ovalbumin. We also have investigated the ability of administered IL-12 to induce IL-18 receptor (IL-18R) expression that may lead possible synergic action of IL-12 with endogenous IL-18. METHODS: C57BL/6 mice immunized to ovalbumin (OVA) by intraperitoneal (i.p.) injection, were challenged three times with an aerosol of OVA every second day for 8 days. Recombinant IL-12 (500 ng) was intravenously administered on a single occasion 1 h after the final challenge of mice. Mice were analysed for effects of IL-12 on AHR, inflammatory cell infiltration and cytokine levels in lung tissue as well as serum immunoglobulin (Ig) E levels. Immunohistochemistry for IL-18R was performed using rat monoclonal antibody specific for murine IL-18Ralpha (IL-1 receptor related protein; IL-1Rrp). RESULTS: An intravenous IL-12 administration diminished AHR, pulmonary eosinophilia and T lymphocyte infiltration, serum IgE, IL-4 and IL-13 in lung tissue. Expression of IL-18R was induced in the mononuclear cells in the lung of mice exposed to OVA. IL-12 administration enhanced the IL-18R expression compared with the control. CONCLUSION: These data indicate that IL-12 can attenuate established antigen-induced AHR and inflammation. In this mechanism it would be interpreted as follows: IL-12 administration in OVA-challenged mice decreased IL-4 production and IgE production thereafter through direct effect on inhibiting the activation of established Th2 cells response and also combined effect with up-regulation of IL-18R expression by inflammatory cells in the lung.     

Polymorphous low-grade adenocarcinoma of submandibular gland origin

A case of polymorphous low-grade adenocarcinoma (PLGA) in the submandibular gland is reported. A 72 year old woman presented with a 5 year history of a gradually expanding tumor in the submandibular region. The surgical specimen revealed a relatively well demarcated tumor, 35 × 35 × 20 mm in size. Macroscopically, necrosis and hemorrhage were not seen in the solid tumor. Histologically, the tumor growth pattern was variable, composed of tubular, papillary, solid, trabecular and cribriform structures. Immunohistochemically, some tumor cells were positive for epithelial membrane antigen (EMA), S-100 protein, keratin, and carcino-embryonic antigen (CEA). Electron microscopically, prominent microvilli projected into the luminal spaces, and basal lamina and hemidesmosomes were seen in the tumor cells adjacent to the connective tissues. The submandibular gland is an extremely rare location for PLGA. To the authors' knowledge, this is the first case of its kind reported in the English literature.     

Immunoregulatory effect of antibody on delayed-type hypersensitivity in mice

We analyzed the conditions for in vivo toleration of delayed-type hypersensitivity (DTH). The intravenous injection of a high dose of keyhole-limpet hemocyanin (KLH) into BALB/c mice did not induce DTH in vivo, but the serum titers of the anti-KLH antibody were significantly elevated. This lack of DTH response was antigen-specific, and the intravenous injection of the antigen induced effector-phase suppressor T cells. The findings suggested that the lack of a DTH response brought about by the intravenous injection of a high dose of antigen was not immunological tolerance. Treatment with a high dose (250 mg/kg) of cyclophosphamide - but not a low dose (50 mg/kg) - enhanced the DTH, but suppressed antibody production. These results indicate that humoral immune response participate in the regulation of DTH. In addition, the transfer of serum or immunoglobulin from mice that were injected intravenously with a high dose of the antigen suppressed the DTH. We concluded that the antibodies regulate DTH in the antigen-specific manner.