Is laparoscopic colorectal surgery less invasive than classical open surgery? Quantitation of physical activity using an accelerometer to assess postoperative convalescence.

BACKGROUND: With the technical advances of recent years, the number of operative manipulations in the abdominal cavity by laparoscopic surgery is now considered to be the same as that using classical open surgery. The question has been raised whether laparoscopic colorectal surgery with lymphadenectomy improves the recovery compared to open surgery. METHODS: We compared patients' physical activity for 7 days postoperatively as measured with an accelerometer between laparoscopic-assisted colorectal resection (LAC, n = 32) and classical open colorectal surgery (OC, n = 30). RESULTS: Physical activity expressed as cumulative acceleration was significantly higher in the LAC than in the OC group on each postoperative day. The recovery time, defined as the day on which the cumulative acceleration recovered to 90% of the preoperative level, was significantly shorter (p < 0.05) in the LAC (3.4 +/- 1.2 days) than in the OC group (6.8 +/- 1.7 days). CONCLUSION: Our results showed that the duration of convalescence with LAC was significantly shorter than that with the OC procedure. Laparoscopic colorectal surgery appears to allow an earlier recovery after the operation than the classical open procedure, and it is less invasive as assessed by convalescence.

Co(2+)-doped flatband optical fiber attenuator.

The attenuation properties of Co(2+) -doped single-mode optical fibers were experimentally and analytically investigated for preparation of a stable flatband attenuator. By controlling the Co(2+) -doped region in a fiber core, we could prepare a flatband attenuator in which the attenuation in wavelengths 1530-1610 nm was held to within 9.9-10.2 dB (3% variation) and the fluctuation of attenuation was less than 0.1 dB with 1-W input power for 100 h.

Thyroid clear cell adenoma with marked dilatation of membranous structures: electron-microscopic study.

The electron-microscopic features of a thyroid follicular adenoma with clear cell change is described. The tumor was 7 mm in size and located in the upper portion of the left lobe of the thyroid of a 29-year-old Japanese female. Its cut surface was pale brown in color and well demarcated. The lesion consisted of solid nests with pinpoint lumina. The cytoplasm of the tumor cells was completely clear, but slightly vesicular without oncocytic change. Electron-microscopic examination revealed that the cytoplasm of the tumor cells was filled with numerous empty vacuoles. The vacuoles consisted of dilated membranous structures, indicating that they had been formed from rough endoplasmic reticulum and Golgi apparatus. There was no accumulation of glycogen, mucin, or lipid. The dilated membranous structures in the cytoplasm may be related to the increased thyroglobulin synthesis by the tumor.

[A case of short-bowel syndrome treated with parenteral nutrition at home--its effectiveness on improving nutritional status and quality of life].

Although the effectiveness of home parenteral nutrition (HPN) for short-bowel syndrome has already been demonstrated, there are some patients who suffer from severe malnutrition because they cannot be treated with this therapy. We here report the case of a patient with short-bowel syndrome due to massive bowel resection after superior mesenteric artery thrombosis. As she had not received adequate nutritional support, she became severely undernourished and her activities of daily life were very limited during two years after the operation. She was introduced to our department and HPN was initiated. Her nutritional status and quality of life rapidly improved. Thus, we further confirmed the effectiveness of HPN for ambulatory patients with short-bowel syndrome. It is important to take measures not to make patients with short-bowel syndrome, suffering from severe malnutrition without adequate nutritional support, HPN.

Physical effects of negative air ions in a wet sauna.

The physical effects of negative air ions on humans were determined in an experimental sauna room equipped with an ionizer. Thirteen healthy persons took a wet sauna bath (dry bulb temperature 42 degrees C, relative humidity 100%, 10 min exposure) with or without negative air ions. The subjects were not told when they were being exposed to negative air ions. There were no differences in the moods of these persons or changes in their blood pressures between the two saunas. The surface temperatures of the foreheads, hands, and legs in the sauna with negative ions were significantly higher than those in the sauna without ions. The pulse rates and sweat produced in the sauna with ions were significantly higher than those in the sauna without ions. The results suggest that negative ions may amplify the effects on humans of the sauna.

Balneotherapy and platelet glutathione metabolism in type II diabetic patients.

Effects of balneotherapy on platelet glutathione metabolism were investigated in 12 type II (non-insulin-dependent) diabetic patients. Levels of the reduced form of glutathione (GSH) on admission were well correlated with those of fasting plasma glucose (FPG; r = 0.692, P < 0.02). After 4 weeks of balneotherapy, the mean level of GSH showed no changes; however, in well-controlled patients (FPG < 150 mg/dl), the level increased (P < 0.01) and in poorly controlled patients (FPG > 150 mg/dl), the value decreased (P < 0.05). There was a negative correlation between glutathione peroxidase (GPX) activities and the levels of FPG (r = -0.430, P < 0.05). After balneotherapy, the activity increased in 5 patients, decreased in 3 patients and showed no changes (alteration within +/- 3%) in all the other patients. From these findings in diabetic patients we concluded: (1) platelet GSH synthesis appeared to be induced in response to oxidative stress; (2) lowered GPX activities indicated that the antioxidative defense system was impaired; and (3) platelet glutathione metabolism was partially improved by 4 weeks balneotherapy, an effect thought to be dependent on the control status of plasma glucose levels. It is suggested that balneotherapy is beneficial for patients whose platelet antioxidative defense system is damaged, such as those with diabetes mellitus and coronary heart disease.

Elevated levels of heat-shock protein 70 (HSP70) in the mononuclear cells of patients with non-insulin-dependent diabetes mellitus.

Increased free radicals and reduced levels of antioxidants have been reported in diabetes mellitus. Since heat-shock protein 70 (HSP70) is a stress-induced protein and is suggested to play a protective role against oxidative stress, we have investigated whether HSP7O acts as one of the defense systems against this stress. We separated mononuclear cells from diabetic patients (N=12) and age- and sex-matched healthy controls (N =12), and detected HSP70 by western blot analysis. The results were expressed by the ratio of the density determined by laser densitometry, to that of 10 mu g of purified HSP70. HSP70 levels in the mononuclear cells of diabetic patients (0.78 + or- 0.56) were significantly high, compared with healthy subjects (0.43 + or - 0.23) (P < 0.05). No correlation was found between HSP7O and hemoglobin A1c, fasting plasma glucose, duration of diabetes or diabetic complications except age. A negative correlation was found between HSP70 and age (r = -0.658, P < 0.05). These results suggest that HSP70 levels in the mononuclear cells are elevated reflecting increased oxidative stress in patients with diabetes.

[Study of the interrelation between variation of blood pressure and pulse rate under various respiratory conditions].

By means of non-invasive continuous blood pressure measurement (Finapres method), coefficient of variation for pulse rate (CV-PR) and coefficient of variation for blood pressure (CV-BP) under various respiratory conditions were calculated simultaneously to examine the interrelation between them. The subjects were 148 healthy normal adults and 75 patients with diabetes mellitus (DM). Both coefficients of variation for healthy normal adults showed significantly (p < 0.01) positive correlations: correlation coefficients tended to be greater during deep breathing than that during resting breathing. The case was the same for the ratio of CV-PR to CV-BP (CV-PR/CV-BP): the ratio for deep breathing was approximately 1.0. The ratio showed a significant decrease for DM patients compared with that for healthy normal group. The examination of the interrelation between these coefficients of variation under various respiratory conditions, which reflected the sensitivity of cardiovascular vagal reflex was considered to be also useful for the judgment of the degree of progress of DM-complications.

Thermal stress and diabetic complications.

Activities of erythrocyte aldose reductase were compared in 34 normal subjects, 45 diabetic patients, and nine young men following immersion in water at 25, 39, and 42 degrees C. Mean basal enzyme activity was 1.11 (SEM 0.12) U/g Hb and 2.07 (SEM 0.14) U/g Hb in normal controls and diabetic patients, respectively (P < 0.0001). Activities of the enzyme showed a good correlation with hemaglobin A1 (HbA1) concentrations (P < 0.01) but not with fasting plasma glucose concentrations. After immersion at 42 degrees C for 10 min, enzyme activity was increased by 37.6% (P < 0.01); however, the activity decreased by 52.2% (P < 0.005) after immersion for 10 min at 39 degrees C and by 47.0% (P < 0.05) at 25 degrees C. These changes suggest that heat stress might aggravate diabetic complications, and body exposure to hot environmental conditions is not recommended for diabetic patients.

Mode analysis of optical waveguides: a new approach.

We propose a new numerical method for extracting extreme eigenvalues and the corresponding eigenmodes for very large Hermitian matrices. The method is applied, for what we believe is the first time, to the mode analysis of arbitrarily shaped optical waveguides. Compared with results obtained by other numerical methods, it is shown that our method is powerful with respect to the analysis, modeling, and optimum design of lossless optical waveguides.

A correlation study between blink reflex habituation and clinical state in patients with Parkinson's disease.

The neurologic states and activities of daily life of patients with Parkinson's disease were evaluated using a rating scale with subitems, and subsequently the neurologic disturbance scores and the daily activity impairment scores were obtained. Subjects consisted of 19 normal controls, and 55 ambulatory patients without marked dyskinesia who were on various anti-parkinsonian drugs. Blink reflex was elicited by paired electrical stimulation over the supraorbital nerve. The interval time between the conditioning stimulation and the test stimulation was set at 200 ms, and 5 serial ipsilateral maximal R2 amplitudes on the stimulated side were measured. The mean of the paired maximal R2 amplitude ratio (test/conditioning), expressed as a percentage, was defined as the habituation index. The habituation indices in normal controls and those with Parkinson's disease were 17.1 +/- 7.6 and 51.9 +/- 29.3, respectively (P less than 0.01). The degree of akinesia, rigidity, balance/gait and dysarthria was positively correlated with the habituation index (P less than 0.01), while tremor was not. On the whole the habituation index was found to have a significant correlation not only with the neurologic disturbance score but also with the daily activity impairment score (P less than 0.01).

High-performance liquid chromatographic determination of nifedipine and a trace photodegradation product in hospital prescriptions.

A HPLC method is developed for the assay of nifedipine and trace amounts of a photodegradation product in pulverized tablets used in the preparation of hospital prescriptions. After liquid-liquid extraction, nifedipine and its photodegradation product are chromatographed using a reversed-phase system which involves UV detection at 254 nm and the use of two internal standards. The trace photodegradation product in pulverized tablets is determined along with nifedipine by the same procedure. The method is capable of determining 0.5-5.0 micrograms of nifedipine using p-nitronifedipine as the internal standard and 0.01-0.5 micrograms of the photodegradation product using 5-hydroxynifedipine as the internal standard. The standard error is found to not exceed 8.4%. The methods are useful for the study of the disposition or photostability of nifedipine in tablets and pulverized tablets.

[A case of Moebius syndrome--electrophysiological studies of facial nerve and brainstem].

A five-year old boy was the product of a 40 week pregnancy by vertex presentation complicated only by threatened abortion at approximately 8 weeks gestation. Apgar score was 5 after one minute. At birth he was noted to have a generalized hypotonia associated with facial diplegia, small mandible, weak suck and swallow reflexes. Admission examination revealed small mandible, mask-like facial expression and mild mental retardation. Cranial nerve examination showed bilateral blepharoptosis and facial nerve palsies. Pupil reflexes were normal, but corneal reflexes were impaired bilaterally. Diplopia due to the left abducens nerve palsy was suggested. There was no atrophy of the tongue. Motor tone, strength, and deep tendon reflexes were normal. A normal 46 XY karyotype was present. The other clinical and laboratory findings were normal. MRI of the brain was unremarkable. The characteristics of electrophysiological studies were summarized as follows: 1) Auditory brainstem evoked responses demonstrated waveforms IV-V were abnormal because their amplitudes were less than 30% of wave I bilaterally. 2) Somatosensory evoked potentials documented by central conduction times from cervical region to sensory cortex were prolonged on both sides. 3) Facial nerve conduction velocity was calculated by evoked EMGs of the mentalis muscle electrically stimulated at two distal points over the marginal mandibular branch. MCV of the left side was reduced (34.2 m/sec). 4) The amplitude of the facial muscle potentials evoked by facial nerve stimulation was reduced on both sides. 5) Blink reflex responses documented by the latency difference of R1 responses between the two sides were prolonged.(ABSTRACT TRUNCATED AT 250 WORDS)

An ACTH and FSH producing invasive pituitary adenoma with Crooke's hyalinization.

We report on a patient with ACTH and FSH producing invasive pituitary adenoma complaining of cutaneous pigmentation. Elevations in plasma ACTH, beta-endorphin and cortisol levels as well as urinary 17-OHCS and cortisol excretion were found. Serum FSH concentration was just within the upper limit of the normal range, whereas serum LH level was reduced and alpha-subunit level was normal. Roentogenographic examination showed an almost complete loss of sellar floor and destruction of the posterior clinoids and dorsum sella. CT scan and MRI demonstrated an enlarged tumor invasion of the clivus and its extension to the sphenoid sinus. After subtotal removal of the large pituitary tumor, serum cortisol and plasma beta-endorphin levels as well as plasma ACTH concentrations returned to normal and serum FSH levels also remarkably decreased. Histologically, the tumor corresponded to a chromophobe, slightly PAS positive adenoma. These tumor cells exhibited positive immunostaining with antibody to ACTH (1-24), beta-LPH, beta-endorphin and FSH, while immunostaining of the adenoma cells was negative for LH, TSH, GH and prolactin. The immunogold technique also demonstrated ACTH and FSH particles in the secretory granules in the cytoplasm of the adenoma cells. Some of the tumor cells disclosed Crooke's hyalinization and type I microfilament occupied most of the cytoplasm. In the present study, a very rare case of ACTH and FSH producing invasive pituitary adenoma is reported.

[Age-related interrelation of vibration perception thresholds and somatosensory evoked potentials in normal subjects].

In order to establish the age-related changes of vibration perception thresholds (VPTs) and somatosensory evoked potentials (SEPs), which are known to share a common afferent pathway in the central nervous system, 119 normal subjects ranging in age from the 20s to the 90s were studied. The VPTs of the index fingertip were measured at 63 Hz, 125 Hz and 250 Hz by a Rion vibrometer, nd the latencies of the SEPs to the median nerve stimulation (N9, N13 and N20) were simultaneously evaluated. The VPT, tended to elevate from the 40s, became increased towards higher frequencies (63 Hz less than 125 HZ less than 250 Hz) in the 80s to the 90s, whereas the VPT in younger ages showed just an opposite pattern (63 Hz greater than 125 Hz greater than 250 Hz). None of the height-corrected latencies of N9, N13, N20 and central conduction time (N20-N13) revealed a significant correlation between the VPTs at any frequencies. The age-related decline of vibration sense, therefore, could not be explained solely by the degenerative changes of he posterior column and/or the delay of the peripheral nerve conduction velocity. This phenomenon was rather thought to be compatible with an age-associated characteristics of Pacinian corpuscles.

[A case of pure trigeminal motor neuropathy].

We reported a case of pure trigeminal motor neuropathy. A 57-year-old man was admitted with the complaints of vague headache and left upper limb numbness. Neurological examination showed mild wasting of the right masseter muscle on chewing. The jaw deviated to the right when he opened his mouth fully. Corneal reflex was intact bilaterally and so was the sensation on the face and taste. Mild hemiparesis including the face was observed on the left. Laboratory data including cerebrospinal fluid analysis were normal except for mild glucose intolerance. Blink reflex, brainstem auditory response and trigeminal sensory evoked potential elicited by electric stimulation of the lower lip were all normal. EMG findings obtained from the left masseter and lateral pterygoid muscles were neurogenic. The CT scan demonstrated a characteristically distributed low density area, which substituted the muscle supplied by the motor branch of he trigeminal nerve, namely, the right masseter, temporalis, lateral and medial pterygoid muscles. With MRI, the lesion was high on T1 and T2 weighted images. In addition, spotty high signal intensities suggestive of small infarction were observed in the bilateral centrum semiovale on T2 weighted images. Judging from the above results, the present case was believed to have pure motor trigeminal neuropathy confirmed by electrophysiological findings and image analyses together with clinical features. The mild left hemiparesis was thought to be incidental complication of vascular origin.

[Correlation between somatosensory evoked potentials and long loop reflexes--basic investigation and its application for multiple sclerosis].

Somatosensory evoked potentials (SEPs) and long loop reflexes (LLRs) to the median nerve stimulation were investigated on 25 normal controls and 25 patients with multiple sclerosis (MS). Fifteen normal controls were also subjected to LLR study by the common peroneal nerve stimulation. The mean height were 159 +/- 8.2 cm in normal controls and 160 +/- 8.9 cm in MS, respectively. LLRs were obtained with 100% reproducibility in all cases. Upper limb LLRs were recorded from m. abductor pollicis brevis by trigger stimulation during isotonic contraction of the thumb, while lower limb LLRs were recorded from m. peroneus longus by trigger stimulation during isotonic eversion of the foot. The threshold of LLR was lower than that of short latency reflex (H-wave) with the mean latency of 40.4 +/- 1.5 ms. The height of subjects revealed an obvious positive correlation not only with the latency of LLR but also with N 20 of SEP, whereas central conduction time was not. Furthermore, a significant correlation was present between the latencies of LLR and N 20, showing a twofold gradient of LLR against N20. There was a significantly prolonged latency difference between H-wave and LLR of lower limb as compared with that of upper limb. When the stimulation site was changed from the wrist to the elbow, the latency difference between M-wave and H-wave shortened. This fact, therefore, appears to be against "resonance hypothesis" that LLR is set off according to the intrinsic mechanical oscillation given to the muscle concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of CSF guanase activity in multiple sclerosis: a comparative study on various parameters to monitor the disease activity].

Forty two patients with multiple sclerosis (MS) were subjected to determination of CSF guanase activity, CSF IgG concentration, Tibbling's IgG index and Kurtzke's expanded disability status scale (EDSS) together with multimodal evoked potentials (MEPs), which consisted of somatosensory evoked potentials to arm and leg stimulation, visual evoked potential and auditory brainstem response. All patients were divided into active (n = 28) and inactive (n = 14) group, where an "active" was defined as a case revealing a relapse within one month prior to the study. The results were as follows: 1. CSF guanase activity was significantly high in active MS as compared with inactive MS (p less than 0.001), and the same trend was found in CSF IgG concentration (p less than 0.01), but not in IgG index. 2. Abnormal MEP was closely associated with elevated CSF guanase activity in active MS (p less than 0.05), but not in inactive MS. 3. In regard to the disease activity, EDSS was significantly high in active MS as compared with inactive MS (p less than 0.01), and EDSS was also significantly high in abnormal MEP group (p less than 0.001). 4. EDSS was closely correlated with CSF guanase activity in active MS (p less than 0.005), but not in inactive MS. 5. Judging from serial determinations of the parameters in 6 patients, CSF guanase activity, less susceptive to steroid hormone therapy than CSF immunoglobulin level, was found parallel to EDSS, however, both CSF IgG concentration and IgG index failed to correlated with EDSS. In summary, CSF guanase activity was thought to be a sensitive parameter in multiple sclerosis, reflecting not only the disease activity but also spatial involvement in the CNS.

Prevalence of autonomic disturbances in diabetics as compared with non-diabetics and healthy subjects.

The prevalence of autonomic disturbances in diabetics was investigated using a direct questionnaire. Compared to non-diabetics and healthy subjects, diabetics had a much higher incidence of paresthesia in the limbs (41%) and impotence (66%). These two symptoms proved to be important in diabetic autonomic neuropathy. Other symptoms of autonomic disturbances in diabetics such as postural vertigo, abnormal sweating, diarrhea and constipation, abnormally cold or burning feet, itching, thirst, urinary bladder disturbance and libido decrease in females seemed to be non-specific for diabetic autonomic neuropathy. Paresthesia in the limbs, abnormally cold or burning feet, urine bladder disturbance and impotence were thought to be related to some degree to the duration, severity and complications of diabetes respectively.