Surgical removal of an isolated femoral metastasis of uterine cervical squamous cell carcinoma: a case report and review of the literature.

A bone metastasis from uterine cervical cancer normally indicates short life expectancy. Resection of the lesion is therefore palliative. The authors consider herein whether surgical resection can promote disease control while improving quality of life. A 33-year-old woman -presenting FIGO Stage IB 1 uterine cervical squamous cell carcinoma underwent a radical hysterectomy and pelvic irradiation. Twenty-two-months later, a solitary femoral metastasis was detected. Given the pain, imminent bone fracture, the patient's relative youth, absence of other metastases, and complete control of the primary lesion, wide excision of the lesion, and reconstruction were performed. Sixteen months later, she was disease-free and ambulatory using a cane. The findings of both the present case and the review showed that patients were disease-free for over one year after surgery, suggesting that resection may assist disease control as well as improve patients' quality of life.

Novel ultrasonic bone densitometry based on two longitudinal waves: significant correlation with pQCT measurement values and age-related changes in trabecular bone density, cortical thickness, and elastic modulus of trabecular bone in a normal Japanese population.

UNLABELLED: A reference database for trabecular bone density, cortical thickness, and elastic modulus of trabecular bone for a novel ultrasonic bone densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population. INTRODUCTION: A novel ultrasonic bone densitometry system (LD-100 system) was applied to create a reference database for trabecular bone density (TBD), cortical thickness (CoTh), and elastic modulus of trabecular bone (EMTb) for this device over a wide age range in a normal Japanese population. METHODS: In a comparative study between LD-100 and peripheral quantitative computed tomography (pQCT) systems, 52 individuals were examined by both systems at the same radius simultaneously. To create a reference database, a total of 2,380 healthy subjects (1,179 men, 1,201 women), ages 18-99 years, were examined using the LD-100 system. RESULTS: Highly significant correlations between the LD-100 and pQCT systems were found in TBD (r = 0.877, p < 0.001) and CoTh (r = 0.723, p < 0.001). For the reference database, peak values of TBD, CoTh, and EMTb were observed at 30-34 years (255.09 mg/cm(3)), 20-24 years (5.23 mm), and 20-24 years (4.09 GPa) in men, and at 25-29 years (209.24 mg/cm(3)), 25-29 years (3.98 mm), and 20-24 years (3.33 GPa) in women, respectively. The TBD fell significantly (p < 0.05) beginning at 55-59 years in both sexes, with a relatively rapid decrease in women. The CoTh showed a significant decrease beginning at 40-44 years in men and 50-54 years in women. The EMTb showed a significant decrease beginning at 40-44 years in men and 55-59 years in women. CONCLUSIONS: The LD-100 system is a useful bone densitometry device and the database of age-related changes in TBD, CoTh, and EMTb established in this study will provide fundamental data for future studies related to bone status.

Missing xy-band Fermi surface in 4d transition-metal oxide Sr2RhO4: effect of the octahedra rotation on the electronic structure.

Electronic structures of the 4d transition-metal oxide compound Sr2RhO4 are investigated by angle-resolved photoemission spectroscopy and density-functional electronic structure calculations. In the measured Fermi surfaces (FS) of Sr2RhO4, the xy-band FS sheet expected from the well-established results of the FS of Sr2RuO4 is missing, the volume of which should be different only by one additional electron for Sr2RhO4. The apparent contradiction is resolved by a careful analysis of the band structure where the rotation of octahedra results in the hybridization of e(g) and t(2g) states and thus plays a key role in the determination of the electronic structure near EF. The modification of the FS structure due to the distorted lattice is related to the charge transfer among the orbital states and suggested to be relevant to the metal-insulator transition in Ca(2-x)Sr(x)RuO4.

[Intestinal gallstone obstruction]. / Zhelchnokamennaia obturatsionnaia kishechnaia neprokhodimost'

Three cases of intestinal obstruction due to obturation with gallstones are presented. These patients made 1,3% of all patients operated for acute intestinal obstruction and 0,2% of all patients operated for cholelithiasis. This variant of intestinal obstruction is rare disease and is not characterized with a typical picture and specific symptoms. Analysis of complaints, anamnesis, additional methods of abdominal examination help to suspect biliary ileus. In emergency cases scope of surgery must be minimal and directed to adequate elimination of intestinal obstruction. Indications for simultaneous disjunction of biliodigestive fistula depend on many factors which must be regarded individually for each patient.

Changes in occlusal state of patients with mandibular prognathism after orthognathic surgery: a pilot study.

This study examined the occlusal state of patients with mandibular prognathism and compared it with that of adults with normal occlusion (controls). It also examined changes in occlusal state after orthognathic operations in these patients. The values of occlusal contact area and bite force in patients before operation were significantly lower than in controls, and occlusal pressure in patients was higher than in controls. The occlusal contact area and bite force of the patients 1 month after the operation had decreased to below preoperative values. These values 12 months after the operation had increased by 2.0 and 1.8 times in women and 1.4 and 1.4 times in men, respectively, compared with preoperative values. However, absolute values remained extremely low compared with those of controls. In contrast to the above, occlusal pressure reached its maximum value 1 month after the operation and at 12 months it was close to the value for controls.

Long-term results of rotational acetabular osteotomy in patients with slight narrowing of the joint space on preoperative radiographic findings.

Between 1975 and 1984, we performed rotational acetabular osteotomy in 22 female patients with painful hip dysplasia. At the time of surgery, the patients were in their twenties, and radiographs showed slight narrowing of the joint space. Of these patients, 15 were followed-up for 15 to 22 years (average, 19.8 years) after surgery. The preoperative severity of coxarthrosis in all 15 hips was graded as stage II, according to the classification of coxarthrosis advocated by the Japanese Orthopaedic Association. All 15 patients available for follow-up had had no additional operations on the operated side during the follow-up period. At the time of follow-up, the patients were aged 41 to 48 years (average, 44.3 years). Of the 15 patients, 12 had little or no pain and 14 could walk for more than 30 min without a cane; the severity of coxarthrosis was graded stage I in 3 hips, stage II in 4 hips, stage III in 5 hips, and stage IV in 3 hips. We conclude that rotational acetabular osteotomy is efficacious for patients who have preoperative radiographic findings of slight narrowing of the joint space.

Long-term results of rotational acetabular osteotomy in young patients with advanced osteoarthrosis of the hip.

Between 1974 and 1987, we performed 38 rotational acetabular osteotomies to treat advanced coxarthrosis caused by acetabular dysplasia in 38 patients who were aged 40 years old or less at the time of surgery. Of these patients, 28 were followed-up for more than 10 years after surgery. The preoperative severity of coxarthrosis was graded as stage III in 21 hips and as stage IV in 7 hips, according to our modification of the classification of coxarthrosis advocated by the Japanese Orthopaedic Association. At the time of follow-up, 27 patients retained their own hip joints on the operated side 10 to 18 years (average, 13 years) after surgery, and the remaining patient had had a secondary total hip replacement 7 years after the surgery. Of the 27 patients who retained their own hip joints on the operated side, 20 had little or no pain and none suffered from severe pain in the operated hip; the severity of coxarthrosis was graded as stage II in 4 hips, as stage III in 9 hips, and as stage IV in 14 hips. We conclude that rotational acetabular osteotomy can be a useful procedure in young patients who have advanced coxarthrosis secondary to acetabular dysplasia.

[A case report of Campylobacter fetus subspecies fetus oophoritis].

A 45-year-old female with oophoritis (pelvic inflammatory disease) caused by Campylobacter fetus (C. fetus) is reported. She was admitted to the hospital because of high fever and an acute abdomen. On admission, severe inflammation was observed by the laboratory findings, and abdominal X-ray and CT scan revealed ileus with marked swelling of the right ovary. Laparotomy was performed with adonexooophrectomy due to the tubo-ovarian abscesses. C. fetus was isolated from the right ovary, salpinx and ascites. Erythromycin was administered after a sensitive test of C. fetus as the bacteria was isolated at operation. She was discharged on the 17th day after her admission. Indirect immunofluorescent test with hyperimmune rabbit sera to isolated C. fetus revealed a fine to coarse granular immunoreaction in the cytoplasm of the macrophages infiltrated in the tissue. This result was interpreted as the existence and growth of bacteria in the right ovarian tissue. Oophoritis due to C. fetus subspecies fetus is very rare. To our knowledge, this case is the second case reported in Japan.

A new technique of laparoscopic obturator hernia repair: report of a case.

An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal loop was thus achieved. Because the hernial opening measured 5mm in diameter, it could be closed with four pieces of End-Universal stapler without polypropylene mesh. The ischemic ileum was resected, and the bowel was anastomosed extracorporeally with a minimal skin incision. She was ambulant on the first postoperative day, and her postoperative course was good. Obturator hernias are rare, but when a definitive diagnosis is made in such elderly patients, laparoscopic repair using the peritoneal needle retractor is recommended for minimally invasive surgery. We recommend doing the repair with an End-Universal stapler, since this procedure is more simple and useful for preventing infection than using polypropylene mesh in such a strangulated case.

Oral malignant melanoma: long-term follow up in three patients.

Three patients with oral malignant melanoma, who survived for at least ten years after initial examination, are presented. The depth of tumor invasion was 5 mm or less in all patients. The first patient received surgery and postoperative immunotherapy and she had no recurrence more than 18 years after treatment. The second patient underwent surgery but had local recurrence after 11 years. He underwent resection and postoperative chemotherapy and was still alive more than 14 years after initial examination. The third patient received radiotherapy and had metastasis nine months after treatment. Resection and radiotherapy were performed and the patient was alive more than 14 years after first presentation.

Laparoscopic cholecystectomy and time-course changes in renal function. The effect of the retraction method on renal function.

BACKGROUND: Recently, the retraction method has been used to reduce intraabdominal pressure (IAP) during laparoscopic surgery. The purpose of this study was to determine the serial changes in renal function during laparoscopic cholecystectomy (LC) using the retraction method. METHODS: Urine output, effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) were measured serially in seven patients who underwent LC with 12 mmHg pneumoperitoneum (High-IAP group) and five who underwent LC using the retraction method with 4 mmHg pneumoperitoneum (Low-IAP group). RESULTS: Urine output, ERPF, and GFR were decreased during pneumoperitoneum in the High-IAP group, whereas no significant changes in any of these parameters were observed in the Low-IAP group. CONCLUSIONS: Our findings demonstrate that reduction of IAP to 4 mmHg using the retraction method prevents the transient renal dysfunction caused by prolonged 12 mmHg pneumoperitoneum during LC, suggesting that the retraction method reduces the risk of perioperative renal dysfunction during laparoscopic surgery.

The 69-84 amino acid region of the parathyroid hormone molecule is essential for the interaction of the hormone with the binding sites with carboxyl-terminal specificity.

We evaluated the competitive inhibitory effect of intact PTH, the amino-terminal PTH(1-34) fragment, and a series of truncated carboxyl-terminal PTH fragments on the binding of internally 35S-labeled human PTH(1-84) ([35S]hPTH(1-84)) to osteoblastic cells (ROS 17/2.8), in order to identify the minimum and critical elements within the PTH molecule for the interaction with the binding sites specific for the carboxyl-terminal region of the hormone. When the amino-terminal region of the PTH molecule was truncated stepwise, hPTH(35-84), hPTH(53-84) and hPTH(69-84), but not hPTH(70-84), significantly inhibited the [35S]hPTH(1-84) binding. On the other hand, the simple deletion of the carboxyl-terminal glutamine at position 84 of hPTH(53-84) [hPTH(53-83)] resulted in blunting the inhibitory effect of the peptide on the [35S]hPTH(1-84) binding. Furthermore, hPTH(35-84), hPTH(53-84) and hPTH(69-84), but not hPTH(70-84) nor hPTH(53-83), augmented the inhibitory effect of the amino-terminal PTH fragment [hPTH(1-34)] on the [35S]hPTH(1-84) binding. Of special interest was that the combination of hPTH(1-34) and hPTH(35-84) reproduced the inhibitory effect of unlabeled hPTH(1-84) on the [35S]hPTH(1-84) binding, on an equimolar basis. The 69-84 region of the PTH molecule thus appears to be crucial for binding to the carboxyl-terminal specific binding sites for PTH in osteoblasts. The interaction of the amino-terminal and carboxyl-terminal regions of a PTH molecule with their own respective binding sites seemed to occur in a fairly independent manner.

Detection of sheep-associated malignant catarrhal fever virus antibodies by complement fixation tests.

Some serological diagnosis methods and examinations for detection of antibodies to sheep-associated malignant catarrhal fever (MCF) infection were investigated. The wildebeest-associated MCF virus strain WC11 propagated on fetal bovine thyroid cell cultures was used as an antigen. Antibodies were detected by complement fixation (CF) tests in cattle pathologically diagnosed as having sheep-associated MCF, as well as in cattle experimentally infected with MCF virus strain WC11. However, immunodiffusion precipitation was only detected in cattle infected with MCF virus strain WC11. The results of serological investigation by CF tests indicated that 64.3% of sheep possessed antibodies to MCF virus in the Hokkaido district of Japan and all serum samples which contained CF antibody titers greater than 1:4 had antibody titers larger than 1:8 in indirect immunofluorescence tests. The CF test we demonstrated here is available to quantitatively detect MCF virus antibody titers in epidemiological surveys.

[A case of infective mitral endocarditis after percutaneous transvenous mitral commissurotomy].

We encountered a case of infective mitral endocarditis (IE) due to Methicillin resistant staphylococcus aureus (MRSA) after percutaneous transvenous mitral commissurotomy (PTMC). A 65-year-old woman underwent PTMC for mitral stenosis. Two days later, she incurred a fever of more than 40 degrees C, and MRSA was detected in her blood culture. Inflammation and renal function deteriorated despite transvenous administration of antibiotics. Transesophageal echocardiogram revealed vegetation at the mitral valve. Mitral valve replacement was performed after diagnosis of IE, and MRSA was identified from the vegetation. The patient improved with the transvenous application of antibiotics including vancomycin hydrochloride. The blood culture became negative and inflammation was suppressed. In view of this case, we consider that IE is a possible complication following PTMC.

[Surgical treatment of recurrent thymic carcinoid--a case report].

Reoperation for recurrent thymic carcinoid was performed in a 77-year-old man, who had undergone extirpation of an anterior mediastinal tumor in September 1986. The pathological diagnosis was thymic carcinoid after the first operation. An abnormal lesion was found on the chest X-ray film in November 1992. Chest CT and supraclavicular lymph node biopsy revealed that the thymic carcinoid had recurred with lymph node metastasis, so reoperation was performed in February 1993. The patient is alive with residual tumor at 11 months after reoperation. Radiotherapy or chemotherapy are not so effective for thymic carcinoid. However this type of tumor often reocurrs, it grows slowly. Accordingly, total thymectomy including tumor should be carried out for thymic carcinoid, and surgical resection is the best choice for the treatment of tumor recurrence.

Evaluation of the disinfectant effect of a quick drying rubbing type povidone-iodine alcoholic solution by the glove juice method.

The antiseptic effect of povidone-iodine alcoholic solution (HAD Hand Wash), a newly developed quick drying rubbing type disinfectant, was evaluated in 40 subjects. Samples of hand bacteria were collected by the glove juice method. The bacteria were incubated, and a cell count was performed. Disinfection was carried out by rubbing 3 ml of HAD Hand Wash carefully on to the skin of the subjects' hands. The efficacy of the solution was evaluated by computing the bacterial reduction rates as compared to the pre-disinfection bacterial count after disinfecting once and three times. The bacterial cell count was significantly reduced from the pre-disinfection count for one hour after disinfecting once and for two hours after disinfecting three times. In addition, the bacterial reduction rate after disinfecting three times remained superior to that after disinfecting once over a period of two hours. We concluded that disinfecting once with HAD Hand Wash is sufficient for routine hygienic hand washing, while disinfecting three times is desirable when, as with surgical hand washing, the strictest antisepsis is required. HAD Hand Wash produced no adverse side effects.

[Clinical and histological effects of preoperative chemotherapy for squamous cell carcinoma of the tongue].

According to the effect of preoperative chemotherapy for tongue cancer, if the operation method is modified, the modality of treatment for tongue cancer will contribute to preserve the tongue in terms of function and aesthetics as well as improve the quality of life. A clinicopathologic study on 81 patients with tongue cancer was conducted to elucidate the relationship between clinical and histological effects of preoperative chemotherapy with a single agent and multiple-drug regimens, in order to determine the safe surgical margins in the resection of squamous cell carcinoma of the tongue. Fifty patients were treated with bleomycin alone, sixteen with bleomycin and methotrexate and another fifteen with bleomycin, OK-432 and cisplatin. Multiple-drug regimens resulted in greater response rates than the single agent, but there was not always agreement in the relationship between the tumor regression rate and the histological effects of chemotherapy. The histological effects, including the residual aspects of the tumor cell population, were associated with the grade of histological malignancy according to the mode of tumor cell invasion, mitotic index of tumor cell, the tumor differentiation, the degree of stromal lymphocyte infiltration and cellular atypism. These data indicate that special consideration should be also given to the degree of histological malignancy for biopsied specimen, in addition to the tumor regression rate, in determining safe surgical margins and in the modality of treatment of tongue cancer.