MRI screening for acoustic neuroma without gadolinium: value of 3DFT-CISS sequence

To evaluate the efficacy of a gradient-echo sequence (3DFT-CISS) in the diagnosis of acoustic neuromas, two independent observers twice reviewed the images of the temporal bones of 83 patients. Contrast-enhanced T1-weighted spin echo images were used as the reference, showing 18 acoustic neuromas, including 5 purely intracanalicular and one intralabyrinthine tumours. High sensitivity (89-94%), specificity (94-97%) and accuracy (94-95%) were found. Intraobserver (kappa 0.93-1) and interobserver (kappa 0.83-0.84) reproducibility were very good. The smallest intracanalicular tumour was overlooked twice by both observers; the intralabyrinthine tumour once by one observer. All tumours were detected with a less stringent decision criterion, at the expense of lower specificity.     

Preliminary study of tolerance of ambiguity of individuals reporting paranormal experiences

Bromosulfophthalein and papaverine have been demonstrated to inhibit biliary lipid secretion without affecting secretion of bile salts in normal rats, so-called uncoupling. Bromosulfophthalein inhibits the capacity of intracanalicular bile salt micelles to induce biliary lipid secretion, and papaverine inhibits vesicular transport within the hepatocyte. We compared the effects of bromosulfophthalein and papaverine on biliary lipid secretion in normal Sprague-Dawley rats and Eizai hyperbilirubinuria rats. The fatty acyl chain saturation in biliary lecithin increased during bromosulfophthalein infusion and decreased during papaverine infusion in Sprague-Dawley rats. Bromosulfophthalein had no effect on biliary lipid secretion in Eizai rats, while papaverine induced uncoupling. The degree of fatty acyl chain saturation in biliary lecithin was unchanged during bromosulfophthalein infusion, but decreased with papaverine in Eizai rats. We deduce that selection of biliary lecithin species occurs at various points in the lipid transport pathway at intracellular and intracanalicular sites.     

Transverse and T fractures with fracture of the posterior wall of the acetabulum. Results of orthopedic and surgical treatment. Apropos of 52 cases

A patient developed delayed facial nerve palsy at the level of House-Brackmann grade I to grade III 10 days after vestibular schwannoma surgery by the suboccipital transmeatal approach. The palsy had completely recovered after one month. Immunological study showed reactivation of herpes simplex and magnetic resonance (MR) imaging demonstrated an abnormal enhancement pattern of the facial nerve; intense enhancement of the distal intracanalicular segment and labyrinthine segment, similar to the MR findings for Bell's palsy. A prospective control study on the enhancement pattern of the functionally preserved facial nerve after vestibular schwannoma surgery in six cases showed a similar pattern to that of the normal facial nerve. Based on these findings, we propose the hypothesis that herpes simplex reactivation is an underlying cause of delayed facial palsy after vestibular schwannoma surgery.     

Transantral-ethmoidal decompression of optic canal fracture

A case of indirect trauma to the optic nerve was successfully treated with transethmoidal decompression. The literature was reviewed, and reports of poor results from neurosurgical procedures are cited. Improved results from transethmoidal decompression of the optic nerve have been reported by Japanese authors but, in our opinion, without proper selection of cases. Early diagnosis of traumatic compression of the intracanalicular optic nerve as evidenced by delayed and/or progressive vision loss following injury, coupled with prompt transantral-ethmoidal surgical decompression, should yield gratifying results in the treatment of this uncommon condition.     

Hormonal regulation and germ cell-specific expression of heat shock protein 60 (hsp60) in the testis of macaque monkeys (Macaca mulatta and M. fascicularis)

FNA smears from six histologically documented cases of tubular adenoma of breast were critically analysed and compared with 10 histologically confirmed cases of fibroadenoma (five pericanalicular and five intracanalicular). Initially a cytological diagnosis of tubular adenoma was rendered only in one case. On review, two cases could be characterized as tubular adenoma, while the findings were suggestive in two others. The features helpful in diagnosis of tubular adenoma were the presence of benign ductal cells as three-dimensional cohesive balls and tubular structures in highly cellular smears. Stroma was conspicuously scanty or absent. Myoepithelial cells were present along with sheets of ductal cells as well as bipolar naked nuclei. Confusion with fibroadenoma occurred in two cases due to presence of a stag-horn pattern of ductal cells.     

Breast carcinoma and breast saving therapy--a critical comment from the viewpoint of the pathologist

The pathologist's contribution to decision-making for or against breast conserving treatment is based on his examination of the specimen from primary tumour surgery. First-line criteria for the assessment of the specimen are completeness, contour and versus plurifocal/multicentric spread), intracanalicular tumour components, lymphangiosis and haemangiosis. Second-line criteria are the histological and cytological grade of malignancy, preconditions for breast conserving treatment are favorable in consolidated in situ carcinomas up to 25 mm in diameter and in unifocal invasive carcinomas up to stage pT2 with low grade malignancy and without additional intraductal spread or angiosis. Breast conserving treatment is not indicated for multifocal or pT4 carcinomas and for carcinomas with extensive intraductal components or angiosis. When considering an unselected group of breast cancer patients, the pathological anatomic preconditions for breast conserving treatment will be very favourable in one-quarter of the cases. This approach will be feasible with limitations only in another one-fourth of the cases, whereas in about 50% of the patients, breast conserving treatment is dubious or should be rejected.     

Chronic orchialgia. A diagnostic and therapeutic hypothesis

OBJECTIVE: The objective of this study is to offer patients with chronic testicular pain and no physico-pathological finding, a likely cause not usually taken into account such as uricemia. The hypothesis of an intracanalicular deposit of uric crystals and/or the resulting alteration in nerve endings is suggested. METHOD: The study involved a total of 60 patients with chronic orchialgia and no detectable testicular pathology seen over a 5-year period. Mean age 35.6 years. They were all evaluated with routine laboratory tests, uricemia, uricosuria and in specific cases uroculture and Stamey's method. Orchidometry, vascular doppler and ultrasound were used in all cases. RESULTS: Presence of hyperuricemia was corroborated in 61.6% cases. Based on figures found, patients were divided into three groups. Patients were treated with a low-purine diet plus Allopurinol 300 mg/day, and symptoms receded in 81.06% cases. CONCLUSIONS: Due to the high incidence of hyperuricemia and the significant symptomatological relief obtained with specific treatment, we believe its determination should become routine.     

Imaging of the labyrinth and vestibular nerve. Clinical significance for differential diagnosis of vestibular diseases

High resolution magnetic resonance imaging (HR-MRI) and computed tomography (HR-CT) of the inner ear are becoming more important for the diagnosis of peripheral vestibular lesions. Modern HR-MRI techniques allow visualization of detailed anatomic features of the vestibulo-cochlear regions as well as pathologic findings in the inner ear such as, neoplastic lesions (e.g., small intracanalicular acoustic neuromas), anomalies causing vertigo and hearing loss (e.g. Mondini's-malformation, perilymph fistula, vestibular paroxysmia), and inflammatory diseases (e.g., Cogan's syndrome, labyrinthitis, zoster neuritis). HR-CT is still the first examination that should be performed in patients with middle ear diseases (e.g., tumor, infection), trauma (e.g. temporal bone fractures), or fibro-osseous diseases. Although the imaging of the vestibulo-cochlear system has dramatically improved, there are still several peripheral vestibular disorders that cannot be visualized so far, e.g., benign paroxysmal positioning vertigo, idopathic vestibular neuritis or Menière's disease.     

Prediction of facial nerve displacement in extra large vestibular schwannoma

The primary objective in the surgery of extra large vestibular schwannoma is the total removal of the tumour mass while preserving the facial nerve. Preservation of the facial nerve in extra large tumours is reported as being notoriously difficult in the majority of cases. This study was undertaken to evaluate the accuracy in predicting displacement of the facial nerve by preoperative radiological imaging studies in 19 cases of extra large vestibular schwannoma. The direction of displacement of the facial nerve was predicted with preoperative axial and coronal MRI scans and verified intraoperatively. We achieved total removal of tumours in 84.2%, facial nerve displacement was predicted in 80% and we accomplished anatomical preservation in 80%. Prediction of displacement was difficult in tumours with little or no intracanalicular components or with severe bony destruction of the internal acoustic meatus. The preoperative prediction of facial nerve displacement in extra large tumours allows safe internal decompression of the tumour and careful dissection near the predicted area of the facial nerve during the operation. Consequently, a high rate of anatomical preservation of the facial nerve can be achieved.     

Management of displaced lateral orbital wall fractures associated with visual and ocular motility disturbances

Impacted fractures of the lateral orbital wall are a type of orbital blow-in fracture that may be accompanied by decreased visual acuity and ocular motility limitations. Eleven patients who suffered this injury triad were retrospectively reviewed to determine the nature of the ophthalmologic injuries and the effect of fracture reduction on recovery of ophthalmologic functions. Two patients with decreased visual acuity owing to trauma to the globe recovered to subjective pretrauma levels following surgery. Nine patients were thought to have a traumatic optic neuropathy with varying degrees of visual loss. Patients with an injury to the intraorbital portion of the optic nerve and a presurgical visual acuity of 20/400 or better recovered to subjective pretrauma levels. Those with visual acuity of less than 20/400 or an injury to the intracanalicular portion of the nerve had responses ranging from no improvement to objective improvement with large field defects. Ocular motility improved in all patients, many in the immediate postsurgical period consistent with removal of a mechanical restriction. No patients had worsening of ophthalmologic deficits as a result of manipulation of fracture fragments. Our experience suggests that early surgical intervention facilitates recovery of vision and eye movement. The traumatic optic neuropathy that accompanies this fracture is distinct from the indirect type of optic nerve injury that may respond to steroids, and the ophthalmoplegia is distinct from the usual traumatic superior orbital fissure syndrome that resolves spontaneously. An understanding of the impacted lateral orbital wall fracture and its ophthalmologic implications is essential for any surgeon who desires to manage craniomaxillofacial injuries.     

Clarifying roles and expectations in home care

Home care nurses work in an entirely different environment from where they were trained. This unique situation requires understanding the difference in the nurse's role in the home, and establishing rules that promote a therapeutic environment.     

Meniere's disease. A neuropsychological study

A neuro-psychological study is described comprising 19 patients with Meniere's Disease who were participating in an experimental lithium therapy programme. The patients evidenced an organic dysfunction which is not entirely periphearl. The interpretation of the results are not incompatible with an attempt to reconcile neuro-psychological and psycho-somatic viewpoints regarding etiological aspects of Meniere's Disease. An evaluation of the lithium effect was performed.     

The highly inappropriate calibrations of statistical significance.

Comments that an article had used the term "highly significant" to describe an empirical result. The author considers such a modifier to statistical significance is entirely inappropriate on 2 counts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early experience with extraperitoneal endoscopic radical retropubic prostatectomy

This article reports our early experience using laparoscopic instruments and techniques when performing radical retropubic prostatectomy through an entirely extraperitoneal endoscopic approach. Two patients with localized adenocarcinoma of the prostate underwent endoscopic radical retropubic prostatectomy through an entirely extraperitoneal approach (EERRP). The procedure was evaluated for its efficacy in removing prostate and seminal vesicles and in effecting complete vesicourethral anastomosis. Operative time, blood loss, hospital stay, and pathology were also evaluated. Complete endoscopic removal of the prostate and seminal vesicles was achieved in both patients. Endoscopic reconstruction of the bladder neck with watertight anastamosis was successful in both. Operative time and estimated blood loss improved from 5 h and 45 min and 600 cc, respectively, in patient 1 to 4 h and 400 cc in patient 2. Hospital stay was 2.5 days for both. The early experience for EERRP is encouraging. Further evaluation to standardize technique and determine its efficacy and role in treating prostate cancer is in order.     

Quality of hearing preservation in acoustic neuroma surgery

OBJECTIVE: This study aimed to investigate the factors affecting the quality of postoperative hearing in acoustic neuroma. STUDY DESIGN: The study was designed as a retrospective case review. SETTING: The study was performed at the Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan. PATIENTS: The subjects were 94 patients with unilateral acoustic neuroma. INTERVENTION: Hearing preservation surgery was performed in the subjects via the extended cranial fossa approach or the middle cranial fossa approach. MAIN OUTCOME MEASURES: The outcome measures included patient's age and gender, hearing level, speech discrimination score, tumor size, and surgical approach. The relationship between the qualities of preoperative and postoperative hearing and the long-term prognosis of preserved hearing also was investigated. RESULTS: In 94 subjects, there were 47 patients whose hearing was preserved (HP group) and 47 patients whose hearing was not preserved (non-HP group). Overall, hearing preservation rate was 50%. There were no significant differences in age, gender, and tumor size between the two groups. The hearing preservation rate was significantly higher in patients with an intracanalicular tumor than that with a larger tumor. The better the preoperative quality of hearing was, the higher the postoperative one. Although the preserved hearing deteriorated after surgery in 4 patients, no significant hearing deterioration was observed in the other 43 patients. CONCLUSIONS: The results of this study indicated that the diagnosis for acoustic neuroma in the early stage with serviceable hearing is the most important to improve the quality of postoperative hearing.     

Emigrated rat neutrophils adhere to cardiac myocytes via alpha 4 integrin

Previous work has shown that neutrophils isolated from whole blood adhere to cardiac-myocytes via CD18 (beta 2 integrin) to cause injury to the heart cells. In vitro, we have found that upon endothelial transmigration, neutrophils can also express alpha 4 beta 1; however, whether this contributes to neutrophil adhesion to parenchymal cells remains entirely unknown. Unstimulated and tumor necrosis factor-alpha-stimulated rat cardiac myocytes adherent to gelatin-coated coverslips supported N-formyl-Met-Leu-Phe (fMLP)-induced neutrophil (isolated from whole blood) adhesion entirely via CD18 (blocked with monoclonal antibody [mAb] WT-3). Emigrated neutrophils spontaneously adhered to cardiac myocytes also entirely via CD18. However, if fMLP was used to restimulate emigrated neutrophils, the adhesion to cardiac myocytes was entirely independent of CD18. Although an anti-alpha 4 integrin antibody (mAb TA-2) alone did not reduce the emigrated neutrophil-myocyte interaction, dual administration of TA-2 and WT-3 reduced adhesion by 81%. alpha 4 integrin was expressed in small amounts on the surface of circulating neutrophils, increased following transmigration, and then increased > 5-fold after restimulation of these emigrated neutrophils. In the presence of the anti-CD18 antibody, a fibronectin fragment (FN-40) but not a vascular cell adhesion molecule-1 antibody (mAb 5F10) inhibitied neutrophil-myocyte interactions by 80%. Similar results were seen when the rat chemokine CINC-gro was used instead of fMLP, suggesting that the alpha 4-dependent adhesion was not specific to fMLP. These data demonstrate that alpha 4 integrin can be physiologically induced to increase in number and avidity after neutrophil emigration and that this adhesion molecule can cause firm adhesion to fibronectin on parenchymal cells, including rat cardiac myocytes.     

Mixed group validation: A method for determining the validity of diagnostic signs without using criterion groups.

To determine whether a sign x distinguishes between X-type and Y-type individuals (Y = not-X), it is necessary to obtain estimates of p(x/X), the probability an X-type shows sign x, and p(x/Y). The traditional method for determining these probabilities, criterion-group validation, involves observing the incidence of x in 1 group consisting entirely of X-types and in a 2nd group consisting entirely of Y-types. Here, equations are developed for obtaining these probabilities by observing the incidence of x in any 2 groups having different, known base rates of X-types. The validation procedure making use of these equations is termed mixed-group validation, and it is pointed out that criterion-group validation is a special (limiting) case of mixed-group validation. Advantages of mixed-group validation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

国产化3800mm宽厚板轧机的设计特点

简要介绍我国宽厚板轧机的建设态势,以一套在建的全国产化3800mm宽厚板轧机为例,从工程概况、生产工艺流程和特点、主要设备选型及工艺平面布置等各个方面,介绍了该宽厚板轧机的特点,展望了我国宽厚板轧机未来的发展趋势。     

Antibiotics in biliary disease: the relative importance of antibiotic concentrations in the bile and serum

A randomised controlled trial has been performed in 150 patients undergoing biliary operations to determine whether an antibiotic which is excreted almost entirely in bile (rifamide) is to be preferred to one having satisfactory serum levels only (gentamicin). Patients were allocated to one of three groups: 50 received gentamicin, 50 received rifamide, and there were 50 controls who received no antibiotic cover. In the absence of duct obstruction, rifamide achieved extremely high bile levels but low serum concentrations. However, in jaundiced patients, both the bile and the serum concentrations of rifamide were too low to be of therapeutic value. The incidence of postoperative sepsis was not reduced by rifamide compared with controls. In contrast, gentamicin achieved adequate serum concentrations in 88% of patients. Despire poor bile levels, gentamicin was associated with a significant reduction of wound infection from 22% to 6% and septicaemia from 14% to 2% compared with controls. To reduce the septic complications of biliary operations, adequate serum levels of an effective antimicrobial are more important than an antibiotic, which is excreted almost entirely into the bile.     

Hydrogen-induced cracking in iron: Morphology and crack path dependence

Cathodic charging of purified iron with hydrogen at room temperature and in the absence of an external stress results in the formation of intergranular and/or transgranular cracks for all purities of iron examined. The transgranular cracks are crystallographic, forming on variants of {110} or possibly {112} planes. The crack path is a sensitive function of heat treating temperature, cooling rate, and interstitial content; the path can be changed systematically and reversibly from entirely transgranular to entirely intergranular by suitable control of these parameters. This change is similar to changes in the low-temperature fracture path of purified iron tested in tension, suggesting that the two effects are controlled by the same mechanism. Although this mechanism is undoubtedly related to the relative amounts and partitioning of solutes between grain boundaries and grain interiors, no detailed explanation is advanced. It is suggested that the answer will have to be found in the details of the interactions between carbon, oxygen, hydrogen, and possibly vacancies.