There are three categories among ischemic cerebrovascular diseases. One is lacunar infarction, another is atherothrombotic infarction, and the last is cardioembolic infarction. Strokes from atherothrombotic origin are increasing in Japan. Stenosis of the cervical carotid artery is a typical atherothrombotic disease. Carotid endarterectomy have been a choice of treatment for carotid stenosis; however, carotid stenting is developing as an alternative treatment for carotid stenosis. In this review, indication and operative techniques of carotid endarterectomy are presented.

View full abstract

Idiopathic macular hole is a full-thickness defect of the neurosensory retina which can be treated by three-port vitrectomy. The pathogenesis is not understood completely, but tangential traction of the vitreous and retinal surface may cause opening of a macular hole. Vitrectomy with or without internal limiting membrane peeling may relieve the tangential traction. The anatomical success rate is 58-85% without internal limiting membrane peeling and 88-95% with internal limiting membrane peeling. A high success rate was achieved in patients who had surgery within 6 months of the onset of symptoms. Among the complications were retinal breaks, retinal detachment, retinal pigment epitheliopathy, and visual field defect, the most serious complication. Temporal visual field defect can be eliminated by reducing the fluid-gas exchange time and stabilizing intraocular pressure during surgery. Nasal visual field defect can be eliminated by the use of a lower concentration of indocyanine green or of triamcinolone acetonide instead of indocyanine green.

View full abstract

A hypothesis of the dualistic chemical evolution to the stabilization of the energy-balance is proposed and explained in connection with the origin of life on the earth. From author's viewpoint, the existence of all things and all phenomena in the universe are closely related to the stabilization of the energy-balance and life is not an exceptional case in this matter. It is presumed that the first life on the earth was formed as the process towards the stabilization of the energy-balance by interactions between the earth and other heavenly body. A white dwarf was considered as this other heavenly body and the base-bonding polypeptide was assumed to be the origin of protein and nucleic acid.

View full abstract

The cell infiltration in breast carcinoma (stromal reaction) and the reactive changes in the axillary lymph nodes were investigated and assessed together with the production of factor inhibiting Ehrlich ascites-cell migration and suppressor factor. We used methods of morphology, immunohistochemistry and migration inhibition assay were applied. The study comprised 144 women with breast carcinoma. Their age at operation varied from 32 to 70 years with the mean (standard deviation) of 50.5 (9.9) years. Among 742 axillary lymph nodes from 144 patients, 125 axillary lymph nodes from 32 patients did not react and we examined the remaining 617 axillary lymph nodes from 112 patients. Reactive changes were found in 282 (45.7%) of these lymph nodes, most of which were in T-cell region (paracortical type) and T-cell and B-cell region (mixed type). The active paracortex in the lymph nodes was related with production both of a factor inhibiting Ehrlich-cell migration and a suppressor factor. We have shown that inhibitory factor was produced from erythrocyte rosette-forming cells and the subset T_R (rerosetting T-cells after incubation of theophylline) was stimulated in vitro with breast-cancer extract. The erythrocyte rosette-forming cells were separated from peripheral blood mononuclear cells and lymph node lymphocytes. The cells found in the subset T_S (non-rerosetting T-cells) produced suppressing factor. The latter could inhibit the proliferation and differentiation of CD8⁺ T-cytotoxic lymphocytes, and possibly damage their function.

View full abstract

In this study, we attempted to evaluate the dynamic function of graft livers after a living donor liver transplantation (LDLT) using technetium-99m-galactosyl-human serum albumin (^99mTc-GSA) scintigraphy. We performed ^99mTc-GSA scintigraphy 24 times in a total of 15 pediatric patients following LDLT. The age at examination (mean±standard deviation) was 7.3±5.54 years. The median interval between the examination and LDLT was 42 months. We converted the time activity curve for the graft to a horizontal mirror image curve and calculated the mean transit time (MTT) and depicted the functional image. The whole graft MTT showed a significant correlation with the receptor index (r=−0.528, p=0.014), total bilirubin (r=0.470, p=0.032) and cholinesterase (r=−0.641, p<0.014), and a marginally significant correlation with the clearance index (r=0.424, p=0.056). The functional image was quite useful for making a visual evaluation of the regional dynamic distribution of ^99mTc-GSA in the graft. We thus consider this modality a valuable adjunct for evaluating the regional deterioration of the dynamic function of the liver following liver transplantation.

View full abstract

We campared the quality of life among patients with mental disorders, their caregivers and general population using the 26-item short form of the World Health Organization Quality of Life (WHOQOL-26). The WHOQOL-26 score was significantly lower in the patients with mental disorders as compared to their caregivers (p=0.021) and the general population (p<0.001); the values of the mean (±standard deviation) of WHOQOL-26 score in the respective groups were 3.00±0.54, 3.18±0.59 and 3.26±0.40. A significantly (p<0.001) negative correlation was observed between the score of the 12-item short form of the General Health Questionnaire (GHQ-12) and WHOQOL-26 score in each of the three groups; the respective correlation coefficients were -0.681, -0.560 and -0.376 in the patients with mental disorders, their caregivers and the general population. Furthermore, the WHOQOL-26 scores in physical and psychological domains were both significantly (p<0.001) lower in the patients with mental disorders as compared to the caregivers or the general population. The caregiver group scored significantly (p<0.001) highest in the WHOQOL-26 social relationship domain, suggesting that they are satisfied with caregiving role or that they receive social support. No significant difference was observed among three groups regarding the WHOQOL-26 score in the environment domain.

View full abstract

A 27-year-old man with a 16-year history of Crohn's disease was referred to our hospital because of general fatigue and electrolyte disorders. The past medical history included chronic renal dysfunction due to renal amyloidosis and permanent ileostomy performed 2 years earlier. Laboratory findings on admission showed hypochloremia, hypokalemia, metabolic alkalosis, and acute deterioration of chronic renal dysfunction. The above disorders were considered to be due to dehydration caused by excessive loss of fluid and electrolyte from the ileostomy. Dehydration and electrolyte disorders were corrected by proper rehydration, which also improved renal dysfunction to the basal level. Although renal failure due to massive ileostomy effluent is rare, clinicians should be aware of possible dehydration in ileostomists, and treat such patients with water and electrolyte.

View full abstract

The overall mortality of fulminant hepatic failure without liver transplantation is around 70%. However, the most critical problem in the management of fulminant hepatic failure is the indication of liver transplantation because this disease is sometimes reversible without such treatment. We encountered a 27-year old patient with acute type fulminant hepatic failure and deep coma (grade V hepatic encephalopathy). Electroencephalography showed generalized low voltage activity in all leads, but cranial computed tomography revealed no diffuse brain edema. The patient was treated with artificial liver support without liver transplantation, and finally recovered without any neurological deficits. The indications for liver transplantation in patients with deep coma are still controversial because the reversibility of severe coma cannot be accurately predicted before the transplantation. Therefore, more data are needed for the correct therapeutic management (with or without liver transplantation) of fulminant hepatic failure.

View full abstract