Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 43, Issue 4
Displaying 1-24 of 24 articles from this issue
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Contents
  • Measurement of blood flow of the peripheral nerve using a laser doppler flow meter-A canine experiment
    Yuji UMEDA
    1998 Volume 43 Issue 4 Pages 576-585
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.576
    JOURNAL FREE ACCESS
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    Objectives : How stripping of the nerve influences circulation around and in the peripheral nerve was the objectives of the present experiment. Materials and methods : The ulnar nerve of adult mongrel dogs was used. A laser doppler flow meter (ALF 21 RD by Advance Co. Japan) was used to obtain measurements. Two small pressure cuffs were applied to the exposed ulnar nerve with an interval of 4 or 8 cm. More than 400 mmHg pressure was applied to the two cuffs (Group 1) or to either cuff (Group 2) after various procedures were successively performed on the nerve segment located between the two cuffs : 1) Exposure of the nerve only, 2) External neurolysis, 3) Division of the extrinsic vessels to the nerve, 4) Epineurectomy. Blood flow was measured before and immediately after the procedure with or without compression, placing a probe directly on the nerve at four different locations. After these measurement, the nerve was transected, and the blood flow at three different locations, 1, 4 and 7 cm from the proximal end of epineurectomy, was also measured. Results : Without pressure. Blood flow after simple exposure of the nerve was 16.4 ml/min/100g in an average. In the 4 cm group, blood flow decreased to 12.1 ml/min/100g by external neurolysis, but there were no significant changes after the other procedures. In the 8 cm group, epineurectomy demonstrated significant decrease (about 50%) in the blood flow. With pressure. In the 4 cm group, simple exposure of the nerve did not cause significant decrease in the blood flow even after pressure was applied to both cuffs, but other procedures after external neurolysis caused a marked decrease in the blood flow. In the 8 cm group, there was a similar tendency but the degree of decrease was less than that in the 4 cm group. Single cuff pressure application demonstrated that in the majority of the cases, blood flow was distally directed, but in four of 22 nerves, blood flow was proximally directed. This was considered due to differences in vascular patterns, that is, differing location of the major nutrient artery to the nerve. Nerve transection demonstrated that epineurectomy performed more than 4 cm decreased blood flow to about 50%. Conclusions : 1) There was a marked decrease in blood flow by 8 cm epineurectomy. 2) There were nerves with proximally-directed blood flow. 3) Epineurectomy of more than 4 cm with nerve transection may significantly disturb the blood flow.
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  • Animal experiment on spinal cord ischemia with evoked potentials by transcranial electrical stimulation
    MASAYUKI NEMOTO
    1998 Volume 43 Issue 4 Pages 586-598
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.586
    JOURNAL FREE ACCESS
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    Objectives : Spinal cord ischemia during surgical interventions sometimes results in paraplegia or paraparesis. Using dogs, we investigated whether spinal cord monitoring can be a useful method of detecting spinal cord ischemia. Materials and methods : Thirty young mongrel dogs were used. The thoracic cavity was opened and the aorta was exposed and clamped above the T6 vertebral body for two hours (Experiment 1) or one hour (Experiment 2). In Experiment 2, the animals were maintained for 24 hours postoperatively to check for the presence of paralysis. Transcranial electrical stimulation was given according to Levy's method and descending motor evoked potentials (MEP) were recorded with an 8-channel mapping electrode placed on the posterior portion of the dura at the T10 level after laminectomy. Spinal cord blood flow (SCBF) was also measured with a Laser-Doppler flow meter, placing the probe directly on the dorsal surface of the spinal cord at the level of T11. The spinal cords from 15 dogs in Experiment 2 were examined histologically. Results : In Experiment 1, the MEP amplitudes were at least 50% or more of the preclamping level in 10 dogs, but lower amplitudes were noted in five dogs. SCBF was maintained between 25 and 75% of the pre-clamping value in the former, whereas it was 20% or less in the latter. In Experiment 2, 11 dogs maintained 50% or more of the MEP amplitude and 25% or more of the blood flow. These animals showed no sign of spinal cord damage, but histology of the spinal cord demonstrated slight evidence of hemorrhage and congestion. Four dogs showed below 50% amplitude and below 20% SCBF. Two of these animals showed complete paralysis of the hind limbs, whereas the remaining two did not show paralysis. In the two paralysed dogs, there was evidence of necrosis in the posterior horn and sporadic necrosis in the anterior horn. In the remaining two dogs, however, slight necrosis was found in the posterior horn. Conclusion : MEP definitely detected spinal cord ischemia in the present animal model. When the MEP amplitude rapidly decreased to 50% or less of the pre-clamping level, there was a definite possibility of irreversible changes in the spinal cord. This method could be a useful adjunct to spinal cord monitoring.
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  • A histopathological analysis of the athlete's hearts obtained by endomyocardial biopsy
    NOBUHIRO ICHIKI
    1998 Volume 43 Issue 4 Pages 599-612
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.599
    JOURNAL FREE ACCESS
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    Objective : Although athlete's heart is usually considered a reversible physiologic adaptation to hemodynamic overload, some may progress to a pathological state such as cardiomyopathy. The transition process should be clarified. Materials and methods : Endomyocardial biopsy specimens taken from 18 athletes, were microscopically examined and findings compared to those in control group of 12 hypertrophic cardiomyopathy (HCM), 12 hypertensive heart disease (HHD), and 8 normotensive hearts (NT). Results : The athlete's hearts showed ECG changes in T wave change in 18/18 (giant negative T wave in 8/18), ventricular premature beat in 2/18, high voltage QRS in 13/18, and abnormal Q in 4/18 cases. Their ventriculogram revealed apical hypertrophy in 8/18 (cycle racer4, runner 1, boxer 1), diffuse hypertrophy in 5/18 and LV midportion hypertrophy in 1/18, and mild hypofunction with less than 60% ejection fraction in 6/18 cases. Results of the histological examination were as follows : mean diameter of the myocytes was 18μ in the right ventricle and 22μ in the left ventricle and the myocyte-disorientation area comprised 45%. The disorientation grade was less than that in HCM, but more than that in either HHD or NT, and the area became wider with aging and prolonged athletic career. The small fibrotic area was similar to that in NT, and less than that in HCM or HHD. Conclusion : Disorientation of myocyte lines in athlete's heart indicates the initial stage of remodeling in the myocardium to adapt to hemodynamic stress. When the overload is excessive and persistent, the disorientation mimics the disarray in HCM of the apical hypertrophy type and the process may become irreversible resulting in an undesirable prognosis.
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  • Structural alteration of myocardial layers in hypertrophic cardiomyopathy
    --in relation to disarray--
    NOBUYO SADAKARI, SACHIO KAWAI
    1998 Volume 43 Issue 4 Pages 613-622
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.613
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    Objective : We investigated changes at the level of the muscular layers constructing the ventricular wall in patients with hypertrophic cardiomyopathy as well as their relation to disarray. Materials : Twelve autopsied hearts (mean age 42 years) with HCM diagnosed clinically and at autopsy, and 7 controls (mean age 47 years) including hypertrophic hearts were macro--and microscopically studied. Methods : We observed the macroscopic structure of the myocardial layers using a loupe, panoramic photographs of the transverse cut surfaces in the middle regions of both ventricles in 12 HCM cases. We macroscopically scored the grade of disarrangement in the myocardial layer structure in the regions of the ventricular septum as well as anterior, lateral and posterior walls, and compared with the scores indicating the degree of disarray evaluated histologically. The myocyte orientation angle at ten points on the ventricular septum was also determined in 7 (mean age 29 years) of 12 HCM cases and compared with the 7 control hearts (mean age 47 years) including hypertrophic hearts. Results : The median circular layer had disappeared in the ventricular septum of HCM and this was particularly obvious in cases with asymmetric septal hypertrophy. Disarrangement of the layer structure and the degree of disarray in the myocytes showed a rough positive correlation. The myocyte orientation angles at 5/10 (The fifth point from the endocardium of the left ventricle on the ventricular septum) and 6/10 (slightly outer to the fifth point) middle layer regions in the control group were relatively small at 15.6°±7.0°and 11.4. ±4.3°respectively, i. e., the angles were close to the horizontal circular shape, while the angles were significantly larger in the HCM group, 32.8°±8.5°and 22.0°±4.0°respectively (p<0.01). Conclusions : In HCM, various degrees of structural abnormalities were seen not only at the cellular level or myocytic bundle level but also at the structural level of the layers. In particular, the normal layer--Structure was no longer macroscopically apparent in the median circular layer and this finding was marked in the ventricular septum. Disarrangment of the layer structure and disarray at the myocytes were roughly correlated. The myocyte orientation angle in the ventricular septum was significantly larger in HCM, indicating the disappearance of the median circular layer.
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  • A study of heterogeneity of non rheumatic valvular disease
    -pathologicalanalysisofsurgicallyexcisedvalves-
    FUMIHIRO SAITOH
    1998 Volume 43 Issue 4 Pages 623-634
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.623
    JOURNAL FREE ACCESS
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    In Japan as in the West, the incidence of non-rheumatic valve disease has been increasing. However, the etiological basis of non-rheumatic valve disease remains unclarified. Material : One-hundred and fifty-one valve specimens surgically resected at the Cardiovascular Institute Hospital (1987-1994) were investigated. The patients were carefully examined by preoperative echocardiogram, and the macroscopic and microscopic findings of each specimen were studied. These cases were divided into pure regurgitation and stenosis-groups based on the echocardiographic findings, and rheumatic and non-rheumatic groups based on the presence or absence of commissural fusion of the valves. Results : Non-rheumatic valvular disease was present in 79 patients (52.3%). Aortic, mitral and double valve replacements were performed in 49, 36 and 6 patients, respectively. The pure aortic valve regurgitation group consisted of 8 cases of infective endocarditis, 9 cases of valve prolapse, and one case each of aortitis syndrome, Behcet's disease, connective tissue disease, annulo-aortic ectsia, true and dissecting aneurysm of the aorta. Nineteen of the 25 cases in the aortic stenosis group had a bicuspid aortic valve. Thirty-six cases in the pure mitral regurgitation group consisted of 8 cases of infective endocarditis, one case each of hypertrophic cardiomyopathy and ischemic heart disease, 2 cases of patient ductus arteriosus and 24 cases of mitral valve prolapse. Cases of mitral valve prolapse were divided into 4 subgroups : rupture of chordae tendinea (15), absence of chordae (7) (complicated with chordal rupture), looping chordae (5) and idiopathic mitral valve prolapse (4). Post-inflammatory changes were observed in 2 cases of idiopathic mitral valve prolapse. Conclusions : Predisposing disorders of non-rheumatic valvular disease include bicuspid valve, sclerosis, looping chordae of the mitral valve, absence of chordae and post-inflammatory valvular disease. Looping chordae and absence of chordae may partly involve secondary changes resulting from rupture of the chordae.
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  • Prediction of curve progression in idiopathic scoliosis based on multivariate analysis of roentgenological risk factors
    TAKUO YAMAGUCHI
    1998 Volume 43 Issue 4 Pages 635-645
    Published: March 30, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.43.635
    JOURNAL FREE ACCESS
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    Objectives : Since the system of screening students for scoliosis was established some 15 years ago, a large number of patients with mild or moderate idiopathic scoliosis have been referred to orthopedic surgeons for adequate treatment. When the patient is considered a candidate for treatment, a brace is usually applied, but this treatment modality is not well accepted by the patients. Determining whether a particular patient requires a brace, has not yet been standardized. The present study developed an equation to predict scoliosis progression in idiopathic scoliosis before skeletal maturity of the patient and utilized this equation to select candidates for treatment. Materials and methods : Female patients with idiopathic scoliosis who had been periodically observed without treatment or who had shown poor compliance with brace therapy were selected for the study. There were 112 patients with 122 spinal curves (102 single curves and 10 double curves) treated at the Scoliosis Clinic of Juntendo University Hospital who met these criteria. The magnitude of Cobb angle at the time of initial examination ranged from 20 to 45 degrees (aver. 28.6 degrees). Twelve roentgenological parameters, most of which were reported as “risk factors” by various authors, were selected for the study. These parameters were used to evaluate spinalfilms obtained at the initial consultation. Correlation between the parameters and the actual progression of the curves of the patients were analyzed, and their relative weights were studied by a multivariate analysis method. Results : Through the analysis of 12 parameters, five heavily weighted factors were selected : 1) Cobb angle, 2) rotation of the apical vertebra, 3) deviation of the apical vertebra, 4) Risser's expected correction angle : (standing Cobb-supine Cobb) ×3 (degrees) and5) maturation index of the iliac apophysis (Risser sign). Then, using a multiple regression analysis, the first equation was established to correlate the actual progression and the predicted progression, the multiple correlation coefficient being 0.739 (Fig. 5). This equation was then tested using 17 other curves from another scoliosis clinic and 34 additional curves from the author's clinic. The test demonstrated the adequacy of the equation in predicting curve progression. By including data from these 51 curves, the equation slightly modified, and the second equation was produced and proposed for a wider clinical trial. Conclusion : To predict scoliosis progression, an equation was established. This equation is easily applicable to female patients with moderate idiopathic scoliosis and will help physicians determine whether the patient needs treatment.
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