Okayama University Medical School

Over the last three years, we have used ventricular assist devices (VAD) in 7 patients. Of these 7, four patients with combined aortic and mitral valvular disease underwent double valve replacement; one patient with annuloaortic ectasia underwent a Cabrol's operation; another had aortic valve replacement; the last patient had triple coronary artery bypass grafts. The only patient who could be weaned from CPB developed cardiogenic shock after the operation. LVADs supported 6 patients for 4 to 8 days and a BVAD supported one patient for 9 days. All patients survived the weaning procedure. Three were discharged from the hospital and survived 7 to 21 months. The 4 other patients died of multiple organ failure. Three of these four suffered from both renal failure and infection, while one patient had arrhythmia and died of ileus. These data suggest that renal failure and major infection can be serious detrimental complications to VAD support.

Twenty-five cases of paraplegia due to fracture-dislocations of the thoracic and lumbar vertebrae were treated using the halo-pelvic apparatus. Thirteen of them only needed the apparatus, two underwent laminectomy, and ten had posterior spinal fusion in addition. The advantages of this method are that gentle reduction can be achieved without severe complications, and that posterior spinal fusion can be performed with this apparatus on, thus enabling an early start to the subsequent exercise program and minimal absence from work.

Fluid-attenuated inversion recovery (FLAIR) imaging of hepatic hemangiomas (10 patients, 16 lesions) and hepatic cysts (8 patients, 10 lesions) was performed. All hemangiomas were hypointense on T1-weighted images and hyperintense on T2-weighted images. With Gd-DTPA (0.1 mmol/kg), all hemangiomas were enhanced but not all cysts. It was necessary to perform contrast enhanced imaging to differentiate hepatic hemangiomas from hepatic cysts. However, on FLAIR imaging, hepatic hemangiomas were strongly hyperintense and 9 of the 10 hepatic cysts were isointense. One of the hepatic cysts was slightly hyperintense. FLAIR images were useful in differential diagnosis of hepatic hemangiomas and hepatic cysts without using Gd-DTPA.

The structural deficits and problems associated with application of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) were investigated. For this purpose, mortality statistics in Japan were examined for bias in the proportions of death causes classified using the ICD-10 four-character subcategory system, particularly the large distribution of cases classified under the .9 (unspecified) codes. The results showed that most deaths due to the 3 major causes were coded into the .9 subcategories. For example, 97.6% of the 607,065 deaths between 1995 and 2007 classified as I21 (acute myocardial infarction) were coded as I21.9 (acute myocardial infarction, unspecified). This suggests that the quality of the data recorded on many death certificates is poor. Thus, to ensure that the fourth-digit-level subcategories of the ICD-10 code system are effectively used to represent mortality data and actual causes of death in Japan, future studies should address the following objectives:(1) to minimize the discrepancy between the ICD classification terms and the names of diseases actually used in clinical practice, and (2) to actively raise awareness among physicians about the need to accurately record death causes on death certificates, since these records form the basis for determining mortality statistics in Japan.

A urinary iron excretion test was carried out in 22 patients with iron deficiency anemia. The iron excretion index was significantly higher in patients with intractable iron deficiency anemia compared with normal subjects and anemic patients who were responsive to iron therapy. The findings suggest that iron excretion may be a factor that modulates the response of patients to iron therapy.

The relationship between past and present lifestyle and urinary excretion of type I collagen cross-linked N-telopeptides (NTx) was studied in 61 Japanese females aged 34-59, with a view toward using NTx excretion rates as a predictor of future osteoporosis. Bone mineral density (BMD) of the lumbar spine, the speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the os calcis, urinary NTx, serum osteocalcin (BGP) and bone-specific alkaline phosphatase (BAP) were measured. Stiffness index (stiffness) was calculated from SOS and BUA. The subjects were asked whether they took regular exercise in their childhood and teen years (in elementary, junior-high, senior-high school and college), the past (20-40 years of age) and present adulthood. Regular calcium intake, smoking habits, alcohol and other beverage consumption and milk consumption were also covered in the questionnaire. The mean NTx values of premenopausal and postmenopausal group were 22.2 and 56.0 nM bone collagen equivalents (BCE)/mM urinary creatinine (Cr), respectively. The group which did not exercise regularly between the ages of 20 and 40 had a higher mean NTx value (40.9 nMBCE/mMCr) than the group which did exercise regularly (22.7 nMBCE/mMCr). In multiple regression analyses, age, stiffness and exercise in past adulthood could explain 43.5% of the NTx variance. For prevention of bone metabolic increases around menopause, habitual exercise in early adulthood seems to be effective.

An attempt was made to establish the method for the estimation of glucuronide formation in vivo using salicylamide and further to study the alteration in the glucuronide formation in liver disease. The results were as follows: 1. The method for the determination of free salicylamide separately from other conjugates of salicylamide in urine, without involving any hydrolysis of the other conjugates, was presented. When 1 g. of salicylamide was administered to the subjects with or without liver injuries, no free salicylamide was detected by the present method in the urine following the salicylamide administration. 2. The analytical method for the determination of salicylamide glucuronide was also devised by employing a hydrolysis with β-glucuronidase. The ratio of the salicylamide liberated by the enzymatic hydrolysis of the 10-hour urine following the administration of 1 g. of salicylamide to the total salicylamide excreted in the same urine was neither affected by the total recovery of the salicylamide nor by the urine volume. This ratio was thus used as a means of estimating the capacity of the glucuronide formation in vivo, although it was considered that the ratio might be affected to some extent by the competition between the glucuronide and other conjugate formations in vivo. 3. As a result of this salicylamide glucuronide excretion test, it was indicated that the in vivo formation of salicylamide glucuronide in the patients with postnecrotic cirrhosis was slightly decreased compared with that in normal controls.

Urethral duplication is a rare congenital anomaly. Although a number of theories have been proposed to describe the embryology of the condition, the actual mechanism of the disorder is still unclear. We report here a case of urethral duplication in a 11-year-old boy complaining of a double stream, and review the current literature on this rare entity.

1. The objective of this investigation was to test the influence of mammary cancer tissue extract on the induction of various tumors by urethan. Three strains of female mice, Balb/c, Zb and Db, were used in this experiment. 2. It was found that urethan was a multipotential carcinogen in the induction of (a) lung tumor, ovarian hemorrhagic cyst, and hemorrhagic lesions in various tissue in Balb/c mice, (b) lung tumor, hepatoma, leukemia, mammary cancer, Harderian gland tumor and hemorrhagic lesions in various tissues such as spleen, mesenteric lymphnode, liver and ovary in Zb strain, and (c) lung tumor, mediastinal lymphoma, leukemia, hepatoma and hemorrhagic lesions in the liver and ovary in Db mice. 3. Mammary cancer tissue extract seemed to have a promotive effect on the generalization of the mediastinal lymphoma induced by urethan in Db female mice.