A major concern after laminectomy is formation of scar tissue, which may result in extradural compression or make subsequent surgery to the same area difficult and hazardous. The main purpose of this study was to investigate the usefulness of a polyvinyl alcohol hydrogel (PVAH) sheet as an interposition over the dura to prevent inflammatory and adhesive reaction after laminectomy. Wide laminectomy was performed at L5 in 60 adult cats. The dura was covered with a PVAH sheet of a free hyplen fat graft or was left without any interposition as a control. Animals were killed at 3 or 12 weeks or at 1 year. In the control group, adhesion of the exposed dura was apparent. Formation of thick fibrous connective tissue was observed between the dura and the paravertebral muscles. In the fat graft group, the dura was separated from the scar tissue by living grafted fat. However, the dura was adherent to the grafted fat and fibroblasts had migrated into the interstitial space. In the PVAH group, only a thin synovium-like layer had formed around the PVAH sheet. PVAH is made of water and alcohol and has been shown to be nontoxic. It is permeable to low molecular weight cells but impermeable to large cells, such as fibroblasts. Thus, the PVAH sheet prevents migration of inflammatory cells, and, subsequently, reduces formation of scar tissue and adhesive reaction in the intraspinal canal. Other beneficial properties are extreme elasticity and low friction, which eliminate mechanical reaction to the spinal cord. It is felt that the PVAH sheet is useful in preventing formation of scar tissue and does not interfere with the dynamic gliding movement of the spinal cord and nerve roots.

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Because of the westernization of the japanese lifestyle, foot disorders have increased especially hallux valgus. Orthopedists are often involved in their treatment. Therapy can be broadly divided into conservative and operative treatments. Conservative treatments may include custom-made shoe insoles, rehabilitation exercise, and medication. Especially, custom-made shoe insoles treatment may be the most orthodox treatment. Generally, custom-made shoe insoles are designed and made by prosthetic orthocists, and made by static alignment reference. But these insoles are often unexpectedly limited to a certain shoe type or structure. Therefore, shoe insole treatment might be misunderstood. So we consider that conservative treatment can not to correct hallux valgus deformity. Surgery is generally considerd inevitable to correct adeformed foot. Since 1987, investigators have found that the shoe insole determines walking behavior, we make shoe insoles ourself by dynamic alignment reference. Our shoe insoles adapt almost all types and structure of shoes. Radiographic studies of hallux valgus show that 26 of 83 toes the angle of correction was more than 5 degrees, angle of the maximal correction was 19 degrees. Hallux valgus deformity could not be satisfactorily corrected when the angle was more than 35 degrees or when the patients was less than 40 years old. Angles more than 5 degrees are seen only in patient more than 40 years old. Therefore, these findings suggested that effective conservative treatment for pain and correction of angle is limited to angles of 35 degrees or less and to patients aged 40 years or more. We make it clear for the first time that the conservative treatment using shoe insoles for hallux valgus can not only relief pain but also correct the deformity.

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The increase in the geriatric population has caused an increase in the incidence of osteoporosis, which may lead to fractures. Furthermore, the problem of bedridden elderly persons is becoming worse in our country. However, the present generation has shown interest in maintaining health by participating in athletics. We report a study of the effects of sports on the prevention of osteoporotic fractures. We conducted a survey of bore mineral density (BMD ; measured by the dual-energy X-ray absorptiometry method) and bone mineral component of the 2nd metatarsal bone (GS/D; measured by the microdensitometry method) in elderly persons who have played gateball, a game similar to croquet, from 1991 to 1995. We compared the BMD and ΣGS/D of gateball players, healthy elderly persons, and elderly persons who had suffered fractures. The BMD and LGS/D of gateball playecs were greater than those of healthy elderly persons, except for femoral neck BMD of women in their 60s and the L2-4 BMD. The BMD and ΣGS/D of gateball players were greater than those of elderly women who had suffered bone fractures. At L2-4, 3 male and 28 female gateball players had a BMD less than the break threshold point (90 percentile of BMD of persons who had suffered bone fractures), and 15 female gateball players had a BMD less than the (60th percentile) . At the femoral neck BMD, 3 male and 19 female gateball players had a BMD less than the break threshold, but none had a BMD less than the break point. We conclude that gateball is effective for prevention of osteoporosis and fractures. In 1992 the BMD of gateball players was maintained for 1 year, except for femoral trochanter BMD. We conclude that the effects of low-intensity sports such as gateball differs in various parts of human bone. In 1995 we followed up 26 players. Compared with those in healthy elderly persons, decreases, of ΣGS/D and L2-4 and femoral neck BMD were less in gateball players. The BMD in five persons who had stopped playeing gateball decreased more than in those who had continued playing. One woman suffered a fracture of the distal radius. From these results we conclude that sports are effective for the prevention of osteoporosis and fractures, and that it is necessary to continue playing sports.

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Stiffness of the upper arm muscles after physical exercise was measured objectively and quantitatively with a newly devised muscle hardness meter. Many studies about muscle stiffness have concerned stiffness caused by rheumatic disease or stroke which was estimated by patient questionnaire or palpation or was defined as the rate of longitudinal extension produced by a given force. These types of stiffness differ from the muscle stiffness that is felt after physical exercise. A newly devised muscle hardness meter was able to measure the depression in a muscle made by applying pressure to the muscle fiber in a direction perpendicular to its long axis. The following results were obtained. 1) The hardness of the extensor digitorum was significantly increased immediately after physical exercise and then decreased later. 2) The hardness of the biceps was significantly increased after two kinds of physical exercises then decreased. These results indicate that muscle hardness measured by this newly devised muscle hardness meter objectively and quantitatively reflects the muscle stiffness that is felt after physical exercise. This muscle hardness meter should prove useful in both medicine and athletics.

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The author studied the size and shapes of the nasolabial triangular area in cleft lip patients. The nasolabial triangular area is bound by the alar base, the nasolabial groove, and the mustache hairline. Cleft lip patients had asymmetry of the nasolabial triangular area. Successful operations resulted in a marked improvement in asymmetry of the nasolabial triangular area in patients with cleft lip.

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The form of the human face interests both anthropologists and ethnologists. After Martin unified the methods of measurement of the human face, many studies were published. We plastic surgeons must know about the form, size, and ratios of the human face. Some studies were performed with X-ray or moiretopography, but most studies used measurements of standar photographs. However, a few papers reported the ratios of transverse facial width to intercanthal distance, the width of the nose, and the width of the lip. In the present study, the author took standard photographs and measured the width of the palpebral fissure, the greatest alar width, the philtrum width, the oral fissure width, and transverse facial width of 56 young Japanese women (mean age, 20.6 years) at rest. The author calculated ratios of measurements and compared the results with those of previous studies. The mean and standard deviation were calculated from each measured value. The average measurements were as follows : width of the palpebral fissure, 28.7±1.72 mm (mean ± SD) ; intercanthal distance, 39.2 ± 2.44 mm ; greatest alar width, 40.0 ± 2.7 mm ; width of oral fissure, 48.9 ± 3.34 mm ; philtrum width, 11.9 ± 1.6 mm ; transverse facial width was 146.8 ± 4.6 mm at the level of the medial canthus ; 135.9 ± 5.45 mm at the level of the greatest alar width, and 115.2 ± 6.51 mm at the level of the oral fissure. The intercanthal distance index was 26.7 ± 2.16, the greatest alar width index was 29.5 ± 1.65, the oral fissure width index was 42.5 ± 3.26, and the philtrum width index was 24.4 ± 3.18. The intercanthal distance-greatest alar width index was 98.1 ± 8.51. The intercanthal distance-oral fissure width index was 80.5 ± 8.92, and the greatest alar width-oral fissure width index was 82.1 ± 6.72. The intercanthal distance and the greatest alar width were almost the same, and were 4/5 of the oral fissure width. The philtrum width was 1/4 of the oral fissure width. The intercanthal distance accounted for 1/4 of the transverse facial width. The greatest alar width accounted for 3/10 of the transverse facial width. The oral fissure width accounted for 2/5 of the transverse facial width. When these results were compared with those of earlier studies, there were differences of 10 to 15 mm in transverse facial width and a maximal difference of 5 mm in oral fissure width. Both this study and erlier studies reported that the philtrum width was 1/4 of the oral fissure width. However, there were differences in intercanthal distance-oral fissure width index and the greatest alar width-oral fissure width index, because the oral fissure width varied among the previous reports.

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Immunohistochemical staining for Ki-67, apoptosis, Bcl-2, and p53 was studied in 41 surgical specimens of submucosally invasive gastric cancer, which can invade and metastasize before reaching an advanced stage. In addition, heterogeneity of immunostaining was analyzed in relation to sites in the tumor. In the normal stomach, few apoptotic cells and p53 positive nuclei were stained. All specimens were stained for Bcl-2 in deeper layers, while the Bcl-2 positivity rate was only 4.9% in the surface layer of the mucosa. The labeling index of Ki-67 was significantly higher in the middle layers than in the surface or deep layers of the mucosa. In gastric cancer, significantly fewer apoptotic cells were seen in deep layers (35±13%) than in the surface and central layers (44±19%) of the tumor. The positivity rate of Bcl-2 in the surface and central layers (7%) was significantly lower than that in the deep layers (46%) of the tumor. The Ki-67 labeling index in the tumor was significantly higher than in normal mucosa, but a significant difference in the distribution of Ki-67 staining in the tumor was not found. Staining rates of Bcl-2 and p53 in differentiated cancers were significantly higher than those in undifferetiated cancers. Positive rates of Ki-67 in histologically heterogenous cancers was higher than in more homogenous cancers. Among histologically heterogenous cancers, there were significantly more apoptotic cells in depressed cancers than in elevated cancers. These results suggest that expression of apoptosis may correlate with invasive potential in submucosally invasive gastric cancer.

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By using a Japanese version of Allport-Vernon's questionnaire, a survey by the aggregate method was conducted of 306 junior-college and 92 university nursing students. The average values of the original test were examined comparatively with Allport-Vernon's scale. Furthermore, with the value orientation form and square table of value orientation devised by Yoshino, value orientations of junior-college and university students concerning subconscious value orientation were compared. Significant differences in the average values of “sociality” and“theory-orientation” were observed between junior-college and university students both on the original test and on subconscious value orientation. Among the various categories, “sociality” had the highest values for both junior-college and university students, and values of “political orientation” and “economic orientation” were low. As for “religiousness”, junior-college students had mimes (-) values and university students had plus (+) values. This result indicates that juniorcollege students had a lower relative value orientation toward religion and, in contrast, college students had a relatively higher value orientation. In the square table of value orientation, characteristics of value orientation of junior-college and university students were concentrated on specific lines and columns with a similar distribution. In view of the common value orientation form on the original test, it was made clear that “political orientation” was (-) and “sociality” was (+) . This finding indicates that the students have such value orientation as they are concerned about human relations with others and are not willing to exercise their own will by force. In veiw of subconscious value orientation, only the (+) in “sociality” was indicated as a common factor. The (+) in “sociality” means that students' value orientations center on human love and seek value in devotion to others and to respect association, sympathy, and solidarity. As mentioned above, as a result of research and analysis of value orientation of students in nursing courses of junior colleges and universities, characteristics of value orientation common in junior-college and university students were understood. An understanding of value orientation is considered important for understanding students' attitudes toward individuals and groups and characteristics of objects in such areas as education. Furthermore, analysis of factors involved in changes of such value orientation would be an extremely important area in such disciplines as psychology and behavioral sciences.

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We studied the relationship between the histological pattern of the prostate and plasma levels of hormones related to development and progression of benign prostatic hypertrophy (BPH) in 16 patients (group A) . Additionally, we investigated hormonal and morphologic changes in 10 patients treated with chlormadinone acetate (group B) . Prostate volume was determined with transrectal ultrasonography. Morphometric analysis was performed with the pointcounting method on prostatic tissue obtained at surgery. The analyzed hormones were luteinizing hormone, follicle stimulating hormone, prolactin, testosterone and estradiol-17β. The average volume density of stromal area was 65.0%, and no significant relationship was demonstrated between each plasma hormone's concentration and relative volume density of stromal area. However, the concentration of plasma testosterone was more closely correlated with relative volume density of stromal area (r=0.435, p=0.092) than was plasma estradion-17β (r=0.389, p=0.134) . These data suggest that testosterone is more closely involved in the development of BPH than is estrogen. Furthermore, prostatic volume and plasma testosterone levels were significantly reduced after treatment with chlormadinone acetate, but no change in the histologic pattern was observed. These dapa suggest that testosterone has different effects in the development and the reduction of BPH.

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One hundred eighty-nine patients with renal cell carcinoma (RCC) were treated at Showa University Hospital and Showa University Fujigaoka Hospital between 1984 and 1993. In regards to Robson's staging, the number of patients with stage I, II, III, and IV disease were 122, 17, 13, and 37, respectively. The overall 5-year survival rate was 71.3 %. The rates for patients with stage I, II, III, and IV disease were 91.7 %, 90.0 %, 52.2 %, and 6.6 %, respectively. Ninety-three cases (49.2 %) were detected incidentally. Seventy-five percent of these cases were detected at other clinics or other sections of our hospital. Ninety cases (96.7 %) of the 93 incidentally detected RCCs were discovered during ultrasonography or computed tomography. Eighty percent of incidentally detected RCC were stage I. The 5-year survival rate in cases of incidentally detected RCC was 88.9 %, which was significantly higher than that in symptomatic cases (55.8 %) . The number of incidentally detected RCC is increasing, because of the diffusion of ultrasonography and computed tomography. Because many cases of RCC were detected in other clinics or other sections of our hospital, it is important to have close relationships with such institutions.

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We established requirements for display of peripheral arteries and veins of the hand on magnetic resonance angiography (MRA) in normal adults. We performed MRA in 20 normal adult volunteers and 3 patients using the same method and parameters and obtained useful clinical examinations. Few studies have evaluated the use of MRA in the hand, especially for peripheral arteries and veins, because of problems of vessel diameter, velocity blood flow, and computer memory capacity. The diagnostic accuracy of MRA is largely dependent on the MR equipment, MR technique, raytracing technique, film reading system, and the skill of the MRA film reader. Because MRA methods are not standardized, optimal methods must be determined that produce the accurate information needed for diagnosis of disease. In 20 normal adults, the following MRA parameters allowed us to consistently visualize the peripheral arteries and veins: flip angle, 90°; TR, 35; TE, 16; slice thickness, 2 mm; FOV, 170; NSA, 2; acquisition matrix, 141×256 ; and room temperature, 22°C. We were able to obtain clear MRA images by the multiple slide slice method, which corrects a weakness of usual methods of display. Results of MRA examinations with our methods and parameters in 20 normal adult volunters and 3 patients suggest that MRA is safe and useful for clinical examination of the hand.

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University of Wisconsin solution (UW) enabled us to preserve whole liver for up to 24 hours and the preservation efficacy of UW has been confirmed at the hepatocellular level. However, we consider preservation of the vessels in the liver to be no less important than that of parenchymal cells to maintain liver function. Rabbit portal veins with and without endothelium were suspended in an organ chamber to measure contractile force. After various incubation periods (4°C) in Krebs solution or UW solution, veins were treated with norepinephrine (10^-4 to 10^-5M, 36°C, 95% O₂ and 5% CO₂) . Veins without endothelium contracted more after 24, 48, and 72 hours of treatment with UW (84%, 83%, and 65% of control) than after treatment with Krebs solution alone (56%, 44%, and 31%) . Veins with endothelium contracted less after 24, 48, and 72 hours of treatment with UW (138%, 119%, and 118%) than after treatment with Krebs solution alone (207%, 237%, and 213%) . These results suggest that UW preserves the contractile function of portal vein with and without endothelium for at least 48 hours.

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To investigate the involvement of hemodialysis in the immunodeficiency of hemodialyzed patients with non-insulin-dependent diabetes mellitus, blood samples were collected during hemodialysis and peripheral blood mononuclear cell subsets were examined 1 day and 3 days after hemodialysis. The CD 3/CD 19 ratio was unchanged at 1 and 3 days after hemodialysis in patients and normal subjects. The ratio of CD 8-positive cells to CD 3-positive cells was decreased by 22.9±9.5% (p<0.01), and the ratio of CD 4-positive cells to CD 3-positive cells was increased by 11.8±7.3 % (p<0.05) 1 day after hemodialysis. The number of monocytes (CD 14-positive cells) decreased 28.8±20.5 % (p<0.05) 1 day after hemodialysis. CD 16 and/or CD 56-positive cells, which represent natural killer cells, increased in normal subjects by 30.7±25.7 % (p<0.05) after 1 day and 44.8±35.3 % (p<0.01) after 3 days, while the number of positive cell decreased in patients by 47.1±25.6 % (p<0.05) after 1 day and 58.2±13.3 (p<0.01) after 3 days. The percentage of IL-2-receptor (β chain) -positive cells among lymphocytes was not changed in normal subjects, but was markedly lower in two patients. Our findings suggest that the immunosuppression of diabetic patients may be worsened by hemodialysis.

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A 52-year-old man had noted the onset of progressive bilateral hearing loss and difficulty in walking at the age of 42. Subsequently, ataxic speech, limb and truncal ataxia, hyperreflexia with bilateral Babinski signs, and bladder disturbance developed over the following 9 years. A tentative diagnosis of olivopontocerebellar atrophy was made. The neurologic status was re-evaluated 10 years after the onset of symptoms. Repeated examinations of the cerebrospinal fluid showed marked xanthochromia and increased levels of protein and iron. Blood tests, including those concerned with iron metabolism, were unremarkable. T₂ weighted magnetic resonance imaging revealed an extremely hypointense band along the surface of the cerebral cortex, cerebellum, brainstem, spinal cord, and the inner surface of the ventricles. These features suggested that superficial siderosis of the central nervous system, which may sometimes mimic spinocerebellar degeneration was a more likely diagnosis in this patient. We may differentiate these two clinical entities by the presence of sensorineural hearing loss, xanthochromic cerebrospinal fluid, and typical magnetic resonanance imaging findings in the former.

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Over the past 7 years, six cases of ligation of the common carotid artery and the vagus nerve occurred during head and neck surgery at Showa University Hospital. Of these 6 cases, 5 involved squamous cell carcinoma of the head and neck region with cervical lymph node metastasis and 1 involved small cell sarcoma of the parapharyngeal space. Ligation was performed during radical surgery in five cases and as treatment for rupture of common carotid artery by recurrent tumor. Reconstructive surgery with a Teflon vein graft to correct a defect of the internal carotid artery was performed in two cases, but the resected vagus nerve was not repaired. The following complications were observed: recurrent nerve palsy in 3 cases, and Homer's syndrome in 2, and cerebral infarction, cardiac arrest at the time of surgery and paralytic ileus in 1 case each. All patients died from 1 month to 19 months after ligation. The cause of death was recurrent tumor in 3 cases, distant metastasis in 2, and systemic complications in 1. Hemiplegia with cerebral infarction probably occurred owing to reconstruction of the common carotid artery but resolved after about 6 months. Cardiac arrest at the time of surgery and paralytic ileus may have been caused by resection of the vagus nerve at the left side of the neck.

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Meningoencephaloceles are rare congenital anomalies. We have experienced three cases of meningoencephalocele and one case of dermoid cyst in the frontal area which was misdiagnosed as meningoencephalocele. The sites were interfrontal, frontoethmoidal, and fronto parietal. The meningoencephaloceles and the bony defects were repaired with an intracranial approach through a coronal incision. The details of the operation are reported.

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