Okayama University Medical School

We report herein the results of anterior or posterior neural decompression with spinal stabilization in 16 patients with spinal metastases. Intractable back pain was relieved in 14 patients (87.5%) and 4 had complete pain relief. Neurologic recovery was observed in 8 out of 13 patients (61.5%) who had some neurologic deficits before surgery. The activities of daily living improved in 7 of 9 (77.7%), and 5 out of 8 patients (62.5%) who had been unable to walk before surgery became ambulatory after surgery. The average operation time was 3h 15 min with an average blood loss of 2150 ml. No patient died within 1 month after surgery and the median survival was 19.1 months. The results indicated that, if properly indicated, anterior or posterior neural decompression and spinal stabilization is a safe and effective treatment for patients with spinal metastases to improve the quality of life for the patients' remaining years.

The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

The medical records of 16 consecutive patients with Crohn's disease surgically treated in our department from 1978 to 1993 were retrospectively reviewed. The indication for surgery was obstructive symptoms due to Crohn's strictures that were unresponsive to conservative therapy. The types of operations performed were classified into five categories. Nine patients (56.3%) had small bowel resection only, 4 (25.0%) underwent an ileocolonic resection, 1 (6.3%) had a total colectomy, 1 (6.3%) had Mile's operation and 1 (6.3%) had subtotal gastrectomy with gastrojejunostomy and antral mucosectomy. Of these 16 patients, 13 (81.3%) had resection with a single anastomosis and strictureplasty was concomitantly performed in only 2 cases (12.5%). Crohn's disease recurred in 3 patients (18.8%), 1 of whom required a second operation.

Factors influencing the prognosis in gastric cancer treated by curative resection include lymph node metastasis and the extent of invasion of the gastric wall. Lymph node metastasis can be removed surgically, but the extent of invasion is not amenable to external measures. Of these two factors, the extent of wall invasion has the greatest influence on prognosis in cases undergoing curative resection. With lymph node removal of equal extent the prognosis worsens in proportion to the depth of invasion. Further, lymph node metastasis increases with increasing depth of invasion. Metastasis was seen in Group 2 and 3 nodes in more than 60% of cancer with invasion beyond the Tunica muscularis propria (pm), indicating that wide lymph node removal is essential in cancers with deep invasion of the wall. The effects of extended radical operation on the host as illustrated by the indices of total serum protein and albumin levels were no different from those of less extensive resections. It was confirmed that extensive radical resection did not delay postoperative recovery.

Surgical treatment of metastatic spinal cord compression is controversial. The purpose of this study was to investigate the effectiveness of our current surgical treatments and the use of spinal instrumentation. In this retrospective study covering the years between 1990 and 2006, 100 patients with spinal metastases which were secondary to various cancers underwent posterior and/or anterior decompression with spinal stabilization for the purposes of reduction of pain, and/or to help correct or improve neurological deficits. The group was made up of 60 men and 40 women whose ages ranged from 16 to 83 years (average of 60 years), and the average follow-up period was 14 months. The effect of treatment upon pain relief and neural deficits was assessed, and the cumulative survival rate was calculated by the Kaplan-Meier method. The average surgical time was 185min. This was calculated based on the following times, listed here with the surgery type:178min for posterior surgery;245min for anterior surgery;465 min for combined surgery;and 475min for total en bloc spondylectomy. Average blood loss during surgery was 1,630 ml for posterior surgery, 1,760 ml for anterior surgery, 1,930 ml for combined surgery, and 3,640 ml for total en bloc spondylectomy. Preoperative pain and paralysis were improved by 88% and 53%, respectively. In regards to surgical complications, postoperative epidural hematoma was observed in 2 patients, and instrumentation-related infection was observed in 1. Only 2 patients died within 2 months of surgery. In conclusion, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases, and can improve their quality of life.

To determine the extent to which recent advances in biomechanical technology have been implemented and to evaluate these new technologies, 84 unilateral above knee (A/K) amputees and their prostheses were surveyed in the Chugoku-Shikoku district of Japan, especially in regard to the types, sockets and components of A/K prostheses currently in use. Background factors such as age and sex of the A/K amputees and the period after amputation were also surveyed. Of the 84 amputees surveyed, 74 (88.1%) were over 40 years old and 40 (47.6%) were over 60 years old. There were 10 women (11.9%) and 74 men (88.1%). The period after amputation was under 25 years in 58 (69.0%) cases. Regarding the type of A/K prostheses, one-third of the prostheses was of the exoskeletal type and two-thirds were of the endoskeletal type. Although the endoskeletal type is becoming more popular recently, elderly A/K amputees tend to use the exoskeletal type. Thirty-one (36.9%) had plug-fit sockets which are preferable for those who follow the Japanese practice of sitting on the floor, especially for elderly amputees. Thirty-seven (44.0%) had a lock-knee, 27 (73.0%) of which were used by amputees over 60 years old. Seventy-three (86.9%) had a single-axis ankle which is generally considered to be the most stable ankle. Thus, the most common combination of prosthetic components for elderly A/K amputees was the plug-fit socket, lock-knee joint and single-axis ankle.

We estimated the number of stray dogs in Kathmandu, Nepal, where human rabies cases still occur, and in Shimotsui, Okayama Prefecture, Japan. In Kathmandu, the stray dog density was 2,930 stray dogs/km2, and the ratio of stray dogs to humans was 1:4.7. In Shimotsui, the density was 225 stray dogs/km2, and the ratio was 1:5.2. Since the stray dog population in Nepal is very large, one of the measures used to prevent dog bites and dog-acquired infections such as rabies is an effort to capture stray dogs. Another such measure is an effort to decrease the availability of food for stray dogs. We also organized health education programs in both Nepal and Okayama Prefecture, Japan, which involved a course on the prevention of dog bites and subsequent infections. After each course, a questionnaire survey was conducted. The results suggest that the course participants understood these important preventive methods. In addition to the measures mentioned above and the routine vaccination of dogs, this health education course is recommended as a long-term preventive program

A simulation model to predict the survival probability of individual patients with hepatocellular carcinoma (HCC) after therapy was derived from the results of various therapies and follow-up studies of 450 HCC patients. Twenty-two prognostically important variables were analyzed by Cox's proportional hazards model. The 9 significant variables that were extracted were used to build the simulation. In this model, S(t), the expected estimated survival rate for individual patient at time t (month), is calculated by the following equation: S(t) = (exp (-0.03655t) (exp [0.9479 ([portal vein invasion]-0.222) + 0.3846 ([tumor number]-2.00) + 0.2578 ([tumor size]-3.231) + 0.0742 ([loge AFP]-5.647) + 0.8184 ([metastasis]-0.036) + 0.2810 ([Child's class]-1.689)-0.7088 ([transcatheter arterial embolization]-0.578)-0.9746 ([percutaneous ethanol injection]-0.153)-0.5377 ([hepatectomy]-0.109)]) The validity of the model was assessed using a split-sample technique. This paper does not discuss the superiority or inferiority of the therapies, because some selection bias for prognostic factors among the therapies can not be completely excluded. But this model is proposed as a practical model to predict the survival of patients with HCC.

The susceptibility of Rous sarcoma virus (RSV) genomes integrated in mouse ascites sarcoma cells (SR-C3H/He cells) to DNase I and DNase II was investigated. Approximately half of the viral sequences were sensitive to DNase I and DNase II when 17% and 7.4% of the chromatin DNA was rendered acid soluble, respectively. The results suggest that newly acquired exogenous proviral sequences are integrated into both transcriptionally active and inactive regions of chromatin in cells lacking related endogenous viral sequences.

Our meticulous investigation of ePTFE graft breakage when a wire placed at the edge of an ePTFE graft was pulled, revealed that, depending on the breakage pattern, a break starts much earlier than the peak suture retention strength, which is the current international indicator for anastomotic-site break strength. Furthermore, the breakage patterns differ based on the thickness of the wire and the fiber direction of the ePTFE graft. Based on these findings, we advocate measuring the peak suture retention strength using 0.10-mm sutures and a standardized wire thickness in order to assess the anastomotic retention strength of ePTFE grafts.

Previous investigation showed that mouse ascites sarcoma cells permeabilized with appropriate concentrations of detergents (Triton X-100, Nonidet P-40 and Brij 58) had high replicative DNA synthesis in the presence of the four deoxyribonucleoside triphosphates, ATP, Mg2+ and proper ionic environment. The present study showed the optimum detergent concentration for DNA synthesis coincided closely with the minimum detergent concentration for inducing cell swelling. Phase contrast microscopy and electron microscopy of Triton-permeabilized cells showed the characteristic swollen cytoplasms and nucleus. Autoradiographic study showed that the DNA synthesis in permeable cells was confined to the nucleus. Cell viability and [3H] deoxythymidine uptake were impaired at much lower concentrations of Triton X-100 than the optimum concentration for in vitro DNA synthesis. In Triton-permeabilized cells, the minimum Triton concentration that produced cell swelling also seemed to produce high repliative DNA synthesis, which reflects the in vivo state of DNA synthesis.

I) On an identified giant neurone of the right parietal ganglion in a snail's subesophageal ganglion-complex, the synaptic contribution to the production of the plateau formation of biopotential or grouped spike discharges of the soma has been studied in the presence of a convulsant. 2) The orthodromic stimulation of a peripheral nerve (the intestinal nerve) can elicit the plateau formation of biopotential, instead of normal spike discharges, in the identified neurone treated with a convulsant. 3) With the application of a convulsant, for example bemegride which was in a concentration less than that necessary to produce the plateau formation, an EPSP accompanied a spike with a constant delay. This EPSP is a product of a proprioceptive reflex arc consisting of two excitatory synapses with a certain subordinate neurone. 4) Later, in the presence of a convulsant, spontaneously conveyed multiple EPSP's were observed on the biopotential of the identified neurone. These multiple EPSP's produced grouped spike discharges or the plateau formation of biopotential of the neurone. 5) The multiple EPSP's may be produced by the grouped spike discharges of the subordinate neurone, the membrane property of which would be changed by a convulsant. It is presumed that the grouped spike discharges or the plateau formation of biopotential often occurs synchron. ously in many neighboring neurones by means of synaptic triggering in the presence of a convulsant.

Human cells derived from malignant tumors (HeLa, HEp-2 and KB) and human cells transformed by tumor viruses (KCand RSb) formed syncytia by simian sarcoma virus type I (SSV-I/SSAV-I), but human diploid or non-transformed cells (WI-38, HEL and HEC) did not.