Peritumoral brain edema is a significant cause of the neurological morbidity associated with brain tumors. Review of the literature on the pathogenesis of the formation of peritumoral brain edema has identified a number of biochemical and morphological abnomalities. The mainstay of medical therapy of peritumoral brain edema is systemic steroids. The mechanisms of action of steroids are reviewed and the new therapeutic modalities are discussed.

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Seroconversion rates after vaccination are influenced by gender, age, vaccine brand and vaccination program. We investigated seroconversion rates after administering recombinant hepatitis B (HB) vaccine in 325 workers in the Showa University Hospital who were negative for HBs antibody. After administration of r-HB “MITSUBISHI” vaccine, HBs antibody was measured and seroconversion rates were calculated. Overall, the seroconversion rate was 93% (768/825) . The seroconversion rates tended to be higher in females (95%) than in males (88%), although the difference was not significant. The seroconversion rates were 93% for subjects aged 29 years or younger and 91% for those aged 30 years or older, showing no significant difference. When each gender group was divided into two age groups, there was a significant difference in the rate between males (88%) and females (95%) aged 29 years or younger (p<0.001) . For those aged 30 years or older, the rate was higher in females, although the difference was not significant. In conclusion, there was a significant difference in seroconversion rates after HB vaccination between genders in subjects aged 29 years or younger.

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We demonstrated examined the roles of specific free radical species on intracellular bactericidal activity of human macrophage-like MABS-1 cells. In an intracellular bactericidal activity assay in which MABS-1 cell phagocytosis and digestion of FITC-conjugated Escherichia coli (E. coli) is detected by FACScan®, almost all phagocytosed E. coli were killed within 3 h, whereas digestion of E. coli was delayed. Inducible nitric oxide synthase (iNOS) was expressed in MABS-1 cell cytosolic fractions, and iNOS inhibitors reduced the intracellular bactericidal activity. Generation of nitric oxide in MABS-1 cells was detected by diaminofluorescent-2 (DAF-2) assay, but not Griess assay, and responded to exposure to tumor necrosis factor and/or interferon-γ. Generation of peroxynitrite, which has strong cytotoxicity, was detected by dihydrorhodamine 123 assay, and N^G-monomethyl-L-arginine, superoxide dismutase and nitrosobenzen, an inhibitor of NADPH oxidase, interfered with peroxynitrite generation. These results suggested that E. coli phagocytosed by MABS-1 cells were killed by nitric oxide (NO) radicals generated by iNOS, and that the killing activity was caused by peroxynitrite rather than NO.

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This study compared the use of general versus local anesthesia in patients who underwent surgical operation for femoral neck fracture between 1992 and 1998 at Showa University Fujigaoka Rehabilitation Hospital. The patients were divided into a general anesthesia with oral intubation group and local anesthesia group (epidural anesthesia or spinal anesthesia) . Complications during the perioperative period and the effects of anesthesia were compared between these groups. The results suggested that, in the selection of anesthetic methods, general anesthesia and local anesthesia have both advantages and disadvatages, and either of these methods can be selected. However, care must be taken to give optimal dosage of anesthetic agents and other drugs in anesthetic management because individual differences among elderly patients, who may have coexisting chronic disease, may influence the outcome.

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The ultrastructure of the amorphous layer (AL) of the articular cartilage surface was investigated by quick-freezing and deep-etching and immunohistochemistry. The uppermost layer of cartilage, which is generally assumed to be amorphous, forms a three-dimensional network of fine filaments, 10-15 nm in diameter. Immunohistochemistry demonstrated that type VI collagen was involved in the AL formation, of sugesting that the AL may correspond to the uppermost layer of the synovial membrane. This also suggested that some components of the synovial membrane remained as remnants on the surface of articular cartilages. Moreover, the density of immunogold staining for fibronectin was much lower in the normal AL than in the cartilagenous superficial layer, but the fbronectin in the AL was densely immunolocalized at some sites of cartilagenous degeneration.

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Effective surgery of the orbit and skull base requires a precise understanding of the anatomy of the orbit. However, we must usually rely on anatomical data that do not account for differences of race, age and sex. We conducted an anatomical study to clarify the precise orbital morphology in thirty Japanese adult cadavers. We measured various two-point distances of the orbit, made three-dimensional analyses, and measured and analysed orbital cast models to determine orbital capacity. We classified the shapes of the supraorbital foramen (SOFo) into four categories. Regression analyses showed no significant correlations between various two-point distances and age. When three-dimensional rectangular coordinates were used for the orbital measurements (X, Y, Z), there was no correlation with either age or sex. There was a slight but conspicuous sex difference in the orbital volume. After measuring the orbital cast models, they were cut into parallel, 5-mm thick, coronal sections. After coronal slicing of the casts, we evaluated the changes in shape using the circularity ratio. Where the orbital bone is destroyed by trauma or invaded by a malignant neoplasm, we expect these data to be useful for surgery of the orbital and skull base.

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A number of new spinal instruments have become available for treatment of the anterior thoraco-lumbar spine. The purpose of this paper is to investigate the incidence and prevention of complications in thoraco-lumbar anterior instrumentation. The mean age of the 36 patients examined was 45.4 y.o. They included 10 fractures, 7 cases of inflammation, 8 malignant tumors, 5 cases of scoliosis and 5 cases of disc disease. Surgery was performed at the thoracic level in 10 patients, the thoracolumbar junction in 11, the lumbar region in 9, the lumbosacral level in one, and extensive thoraco-lumbar lesion in 3 patients. The incidence and counter measures for perisurgical complications in the vascular, respiratory, lymphatic, nervous and genitourinary systems as well as instrumentation failure were analyzed. After anterior decompression procedures, grafted bone fragments injured the lung in one and an anteriorly placed instrument obstructed pulmonary expansion in one patient. Bony and instrumental prominence should be covered by parietal pleura or teflon-patch to prevent lung trauma. Serial stay sutures applied to the whole margin of the separated diaphragm were effective, especially in aged patients whose diaphragm was thin. The extrapleural approach was also recommended to prevent pulmonary complications. CSF leakage into the thoracic cage occurred in one case and was treated conservatively. Extensive exposure of the anterior spinal column induced retropleural chylous pooling which required surgical repair. In one case, the segmental artery was insufficiently ligated and needed reexposure of the wound. Severe osteoporosis induced postoperative local kyphosis in two cases. Preservation of bony endplates, use of the largest available vertebral body spacer (with 30×20mm²), and encircling strut bone grafting yielded good postoperative fusion without loss of correction. Anterior instrumentation surgery yielded the advantages of simultaneous direct decompression and stabilization, however, once complications such as those described here occurred, treatment was difficult. Comprehenseive anatomical knowledge is necessary to prevent such complications.

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Gelatinase activity was assayed in conditioned media from synovial cells cultured from 16 patients with knee joint injury, osteoarthritis (OA) and rheumatoid arthritis (RA) . Production of metalloproteinase-2 (MMP-2) and metalloproteinase-9 (MMP-9) was measured to examine the role of gelatinase in arthrosis-related changes. Using culture supernatant, reactive areas were measured by gelatin zymography. Western blotting demonstrated the production of MMP-9 in all patients. Production of MMP-2 was detected in 9 of 16 patients. MMP-9 production did not differ significantly between the young-age, OA group and RA groups. When RA patients with nonproliferative synovitis due to burnout of inflammation were excluded, MMP-9 production in patients with grade 0, I or II articular destruction was significantly lower than that in those with grade III, IV or V articular destruction, suggesting an association between MMP-9 produced by synovial cells and articular destruction. The response to tumor necrosis factor-α (TNF-α) at 5U/ml of cultured synovial cell production of MMP-9 was not significantly different between the young-age group and OA group, but was significantly higher in both the young-age group and OA group when compared to that in the RA group. Response to interleukin 1-β (IL-1β) at 5U/ml of MMP-9 production was not significantly different when the young-age group was compared to the OA or the RA group, but was significantly higher in OA patients than in RA patients. In patients with RA, the findings suggested that production of MMP-9 by synovial cells is not influenced by TNF-α or IL-1β derived from inflammatory cells but is up-regulated by unknown mechanisms.

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A new human glioblastoma cell line, called GBS-1, was established from a brain tumor of a 53-year-old Japanese female. The cultured tumor cells could be divided into two groups based upon their morphology and immunoreactivity against A2B5 antibody. The modal chromosome number at passage 71 was 78-79 and all cells examined had 17p. Doubling time was 36 hours. Tumor formation was not observed in the back of SCID mice 3 months after subcutaneous inoculation of the tumor cells. Somatostatin was detected in the supernatant of the cultured cells by radioimmunoassay. Expression of somatostatin mRNA was also detected by reverse transcription-polymerase chain reaction (RT-PCR) . Binding assay with ¹²⁵I-somatostatin demonstrated the presence of somatostatin binding sites in the tumor cells.

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Four cases of cecal cancer with appendicitis-like symptoms were compiled. The initial diagnosis in all cases was acute appendicitis, and therefore surgery was performed. The first case was a 75-year-old male with an initial diagnosis of acute appendicitis. After conservative therapy, barium enema revealed a polyp in the cecum. Colonoscopy was performed and biopsies were taken from the tumor. Histopathology revealed adenocarcinoma, and two weeks later the tumor was surgically removed. Three similar cases are also reported. The following possibilities should be included in the differential diagnosis of acute appendicitis: 1) acute appendicitis due to obstruction of the lumen by a tumor; 2) synchronous acute appendicitis and cecal cancer; and 3) cancer causing appendicitis-like symptoms.

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