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Purpose: To introduce a simple technique to create a posterior vitreous detachment (PVD) through the posterior precortical vitreous pocket (PPVP) during microincision vitreous surgery using a wide-angle viewing system (WAVS). Methods: This study included 20 eyes of 20 consecutive patients (mean age, 65.6 years; range, 56-76) with a stage 2 or 3 idiopathic macular hole who underwent 25-gauge microincision vitreous surgery using a WAVS and phacoemulsification surgery. A triamcinolone suspension was injected into the vitreous cavity. The triamcinolone facilitated visualization of the posterior wall of the PPVP. Using a vitreous cutter, we suctioned the outer margin of the PPVP. After a resultant small break of the posterior hyaloid membrane developed and enlarged rapidly, a PVD easily expanded at the periphery. Results: Using this technique, we induced a PVD without close proximity to the optic disk and macula. Conclusion: This technique is an easy and safe method for creating a PVD during microincision vitreous surgery using a WAVS.

Background/Aims: The Japanese version of the Clinician’s Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus J) consists of 3 subscales: Disability Assessment of Dementia Scale (DAD), Behavioral Pathology in Alzheimer’s Disease Rating Scale (Behave-AD), and Mental Function Impairment Scale (MENFIS), as well as the Clinician’s Global Impression of Change (CGIC). While the interrater reliability of CGIC has already been reported, that of the 3 subscales has not. The aim of the present report was to examine the reliabilities of the subscale items and investigate their relationships with CGIC. Methods: Eleven raters who were clinical physicians watched videotapes of 20 patients with Alzheimer’s disease, completed the CIBIC-plus J assessment form, and assigned a CGIC score to the patients. Reliability was assessed using the kappa coefficient. Results: The kappa coefficient of the subscale items was in most instances higher than that of CGIC (0.453) and substantial reliability was observed. The Spearman rank correlation that was calculated between CGIC and the total score change of items was very high for MENFIS (0.990) and DAD (0.910), and moderate for Behave-AD items (0.576). The incidence of comments by the raters was highest for MENFIS (89%), followed by DAD (70%). The incidence was low for Behave-AD items (48%). Conclusion:Based on the results, it is concluded that DAD, Behave-AD, and MENFIS are necessary constituents of CIBIC-plus J, and indispensable for the reliability of CGIC.

Purpose To observe the progression of affected lesions using ultra-wide-field fundus autofluorescence (FAF) in multiple evanescent white dot syndrome. Design Retrospective, observational case series. Methods setting : Institutional. patient population : 14 eyes of 13 patients (mean age, 35.8 years) with acute disease unilaterally. observation procedures : Patients underwent ultra-wide-field FAF, spectral-domain optical coherence tomography (SD OCT), multifocal electroretinography (mfERG), and Goldmann or automated perimetry; the best-corrected visual acuity (BCVA) and refractive error were measured. main outcome measure : Ability of ultra-wide-field FAF to detect lesions with greater sensitivity compared with color fundus photography. Results Ultra-wide-field FAF imaging enabled improved visualization of the affected lesions and showed that the core lesion was in the posterior fundus involving the peripapillary retina and posterior pole and surrounded by hyper-autofluorescent spots outside the vascular arcade. The posterior lesions expanded rapidly and peripheral spots spread farther peripherally and reached a maximal extent during the acute stage. During follow-up, the peripheral hyper-autofluorescent spots resolved and then hyper-autofluorescence of the posterior fundus gradually faded. SD OCT showed diffuse disruption of the photoreceptor inner segment/outer segment junction (IS/OS) in the posterior fundus during the acute stage. The correlation between the IS/OS abnormality and hyper-autofluorescent areas was unclear. The disrupted IS/OS was restored with normalization of the FAF. Conclusions Ultra-wide-field FAF showed that the lesions arise from the peripapillary retina and the posterior pole and spread peripherally in a centrifugal manner during the acute stage. The hyper-autofluorescent spots faded from the periphery in a centripetal manner.

(2001). Proposal of a new medical manipulator for laparoscopic surgery. Advanced Robotics: Vol. 15, No. 3, pp. 379-382.

The anti-biofilm effect of a newly developed antibacterial coating, a mixture of a silver citrate, soybean lecithin and liquid silicon at the ratio of 2:2:8, for silicon catheters was investigated in an in vitro experimental system using a modified Robbins device. The inhibitory effect against bacterial adherence, killing effect against adhered bacteria and durability of these anti-biofilm effects were examined using two strains of Pseudomonas aeruginosa and one of Escherichia coli. Almost complete inhibition of bacterial adherence was demonstrated in the case of one of two strains of P. aeruginosa and E. coli. The more resistant strain of P. aeruginosa OP 14-210 adhered at scattered sites of the silicon with antibacterial coating, while mature biofilm developed on the surface of the silicon without coating. Using already adhered P. aeruginosa OP 14-210, we confirmed the killing effect of silver ion released by this new coating. These anti-biofilm effects did not change after treatment with artificial urine for at least 48 hours.

Helical computed tomography (CT) was used to demonstrate the distribution of crossing vessels in patients with ureteropelvic junction (UPJ) obstruction for planning surgical management. Twenty patients with symptomatic UPJ obstruction were evaluated with dual-phase contrast material-enhanced helical CT. In addition to axial images, coronal, sagittal, and curved paracoronal images along the crossing vessels or the UPJ were obtained by means of multiplanar reconstruction. Crossing vessels were evaluated according to type, position, and association with UPJ obstruction. Fifteen vessels in 12 of the 20 patients were found to cross the UPJ at helical CT. Nine vessels were arteries and six were veins; seven vessels crossed anteriorly and eight crossed posteriorly. In 11 patients, crossing vessels were thought to be associated with UPJ obstruction at helical CT; retroperitoneoscopic repair was performed, and the diagnosis was found to have been accurate in all except one. In the eight patients in whom no significant vessels were seen and the one patient in whom the crossing vessel was not associated with UPJ obstruction at helical CT, endopyelotomy was performed and UPJ obstruction was relieved, with no complications. Helical CT is useful for evaluation of vessels crossing the UPJ and for planning surgical management.

The potency and effectiveness of an anti-bacterial catheter coated with a mixture of silver citrate, soybean lecithin and liquid silicon at the ratio of 2:2:8 were compared with those of commercially available anti-bacterial and conventional urethral catheters. This new anti-bacterial catheter showed a strong activity and excellent durability in ordinary in vitro experimental studies. In the present series we have developed new in vitro experimental models for the evaluation of anti-bacterial catheters in inhibiting bacterial ascent via intraluminal or extraluminal route. The characteristic features of the silver citrate/lecithin catheter, namely strong activity and excellent durability, were confirmed using these new models that mimic urinary catheter-associated clinical infections.

Dear Editor, Oguchi disease, characterized by stationary night blindness, is an inherited and non-progressive retinal disorder that affects the rods and causes impaired night vision [1]. Histologic findings have not been reported. We observed microstructural change of the retina in Oguchi disease using spectral domain optical coherence tomography (SD-OCT). A 31-year-old man had night blindness since childhood. His best-corrected visual acuity was 1.2 bilaterally. On ophthalmoscopic examination (Fig. 1), his fundus had a golden sheen reflex, except for the macular and perimacular areas. The macula had a normal red reflex, but the perimacular area was grayish bilaterally. A full-field ERG showed normal cone and flicker responses; the rod response was non-recordable. Multifocal ERG showed a normal response. The visual field was within normal limits on Goldmann perimetry. He was diagnosed with Oguchi disease. Oguchi disease has five subtypes depending on the location of the golden sheen reflex, i.e., the entire fundus, macula sparing, posterior fundus sparing, peripheral sparing, and far periphery sparing. The current case corresponds to the posterior fundus-sparing type. In a horizontal 6-mm scan across the fovea, the junction between photoreceptor inner and outer segment (IS/OS ) appeared normal in the macula within a 3-mm diameter; however, the distance between the IS/OS and retinal pigment epithelium (RPE) suddenly decreased, and the IS/ OS line was not identifiable in a 3-mm-wide perimacular ring, where the retina was attenuated because of decreased thickness of the outer nuclear layer (ONL). The IS/OS line emerged outside of the perimacular ring in the midperiphery, but the distance between the IS/OS and RPE was short, such that the two reflective lines fused into one broad reflective band in some areas. The midperipheral retinal thickness was normal. SD-OCT (Fig. 2) showed that the distance between the IS/OS line and RPE was short in the midperipheral fundus, which had a golden sheen. However, the IS/OS line appeared normal in the macula, where the fundus color was normal. The IS/OS line was not identifiable in the perimacular area, where the fundus was grayish, resembling an early change in retinitis pigmentosa. Since the IS/OS line indicates high reflectivity at the proximal portion of the photoreceptor outer segment, the decreased distance between the IS/OS and the RPE suggests shortening of the outer segment. OCT suggested that the lesion responsible for the golden sheen reflex appeared to be shortening of the rod outer segment. Full-field ERG showed a normal cone response and a non-recordable rod response. Since the cones were intact, the IS/OS appeared normal in the macula where the cones aggregate, and the fundus reflex was normal. It was noteworthy that the fundus reflex was grayish in the perimacular area where the IS/OS was not identifiable with attenuation of the ONL. The loss of the Graefes Arch Clin Exp Ophthalmol (2009) 247:1561–1563 DOI 10.1007/s00417-009-1114-6

Objective A prospective trial was performed to propose a suitable antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate (TUR-P). Subjects and methods Patients who underwent TUR-P due to symptomatic prostatic hyperplasia between April 1995 and February 1996 were included. Based on the results of urinalysis obtained within preoperative 3 days, the patients were classified into Group I (less than 5 WBC/hpf and bacterial count of less than 10(4) CFU/ml in urine specimen), and Group II (5 or more WBC/hpf or bacterial count of 10(4) or more CFU/ml in urine specimen). Furthermore, each group was randomly subdivided into Group A and Group B according to the period of antimicrobial administration. As prophylactic antimicrobials, cefazolin (CEZ) was used in Group I and CEZ or cefotiam (CTM) in Group II. The antimicrobial was administered only on the day of operation in Group IA (n = 92), for 3 days in Group IB (n = 96), 2 days in Group IIA (n = 37), and 4 days in Group IIB (n = 30). On the day of operation, the antimicrobial was infused immediately before the operation. The presence or absence of pyuria, bacteriuria and febrile infection, and the period required for normalization of the urinalysis were the major points evaluated here. Results No significant differences were observed in any parameters with respect to the period of administration of antimicrobial between the groups, but in both Group I and Group II, the incidence of febrile infection was higher in the groups with shorter antimicrobial administration periods. The mean period for normalization of the urinalysis required 68.4, 68.6, 65.2 and 58.2 days in Group IA, Group IB, Group IIA and Group IIB, respectively. Conclusion It is concluded that 3 or 4-day administration of first or second generation parenteral cephems is generally acceptable regimen for antimicrobial prophylaxis in patients undergoing TUR-P.

We studied the feasibility of imaging the direct correlation between crossing vessels and obstructed ureteropelvic junction with helical (spiral) computerized tomography (CT) for selecting surgical repair of symptomatic ureteropelvic junction obstruction.From July 1995 to December 1995, 4 select patients with symptomatic ureteropelvic junction obstruction underwent contrast enhanced helical CT. In addition to transaxial images, 3-dimensional reformatted images were used for evaluation.We identified 2 cases of ureteropelvic junction obstruction due to crossing vessels regarded as ureterovascular hydronephrosis, which is characterized by the spatial relationship between malrotated renal pelvis and anterior crossing vessels. Laparoscopic or open repair was performed in these 2 patients and operative findings were in agreement with prospective helical CT interpretation. Antegrade endopyelotomy was performed successfully for the remaining 2 patients.The 3-dimensional helical CT is reliable in detecting ureterovascular hydronephrosis preoperatively and in presenting better operative methods for ureteropelvic junction obstruction.

Effects of nivalenol (NIV), a trichothecene mycotoxin, on hepatic drug-metabolizing activity and aflatoxin B 1 (AFB 1 ) metabolism were investigated in male rats. In rats fed the diets containing 6–12 ppm NIV for 2 or 4 wk, decreases in initial feed uptake, terminal weight gain and organ weights were evident. An increase in cytochrome P -450 activity was observed in the hepatic microsomes, and Western blot analysis revealed a transient increase in P 4502B1/2, together with a slight induction of P 4501A2. The activity of cytosolic glutathione S -transferase (GST) enzymes was also enhanced in the rats, and Western blot analysis demonstrated an elevation of GST 1–2. The formation of aflatoxin B 1 -DNA adducts (AFB 1 DNA) was increased in experiments using hepatic microsomal preparations from rats fed the NIV diet, whereas supplementation with cytosol prepared from NIV-treated rats reduced the microsomal potential for adduct formation. In in vivo experiments, the AFB 1 DNA concentration in NIV-treated rats was lower than that in the controls. These results suggest that activities of cytochrome P − 450 and GST enzymes were increased in rats fed NIV for several weeks. Alteration of these phase 1 and phase 2 enzyme levels resulted in the modulation of AFB 1 adduction to DNA in vitro and in vivo .

To report photoreceptor restoration and visual outcomes after vitrectomy for retinal detachment.Retrospective, observational case series.We prospectively studied the tomographic features of reattached retinas in 20 eyes with a macula-off rhegmatogenous retinal detachment using spectral-domain optical coherence tomography 1, 3, and 6 months after 3-port vitrectomy with SF(6) gas tamponade. All eyes were examined more than 3 months after surgery.The optical coherence tomography foveal findings were classified as a disrupted inner segment and outer segment (IS/OS) line, a residual foveal detachment, and a continuous IS/OS line. A disrupted IS/OS line was seen in 11 eyes (55%) at 1 month and in 8 eyes (40%) at 3 months, a foveal detachment was seen in 8 eyes (40%) at 1 month and in 7 eyes (35%) at 3 months, and a continuous IS/OS line was seen in 1 eye (5%) at 1 month and in 5 eyes (25%) at 3 months. In 18 eyes followed up for 6 months, optical coherence tomography showed a disrupted IS/OS line in 3 eyes (17%), a foveal detachment in 6 eyes (33%), and a continuous IS/OS line in 9 eyes (50%). The mean best-corrected visual acuities at 1 and 6 months were 0.26 and 0.16 with a disrupted IS/OS line, 0.60 and 0.95 with a foveal detachment, and 0.8 and 0.95 with a continuous IS/OS line. The mean best-corrected visual acuity was significantly (P.0001) lower with a disrupted IS/OS line compared with the other formations at 6 months.The IS/OS line at the fovea recovered gradually after surgery. The postoperative visual acuity was correlated with a restored IS/OS line.

Infection associated with an indwelling catheter is a representative type of biofilm infection occurring in the urinary tract. Since the most effective way to control this intractable infection is the prevention of bacterial attachment and subsequent biofilm formation on the catheter, the importance of catheter materials and anti-bacterial coating cannot be underestimated. The difference in the degree of bacterial attachment among standard catheter materials, the efficacy of silver-coating of catheters in preventing infection and the potency and effectiveness of a new lecithin/silver coating are discussed.

We developed a new approach of retroperitoneoscopic pyelotomy combined with the transposition of crossing vessels for ureteropelvic junction obstruction as an alternative to conventional antegrade or retrograde endopyelotomy.From February 1997 to August 1999 we treated 5 cases of ureteropelvic junction obstruction due to crossing vessels that were diagnosed by helical computerized tomography. Ureterovascular hydronephrosis characterized by a malrotated renal pelvis with anterior crossing vessels was observed in 4 cases and ureteropelvic junction obstruction with a posterior crossing artery was present in 1. After endoureterotomy stent insertion under cystoscopic guidance we performed retroperitoneoscopic endopyelotomy with the kidney in standard position. Crossing vessels were transposed to a higher position to remove obstruction and fixed with peripelvic tissue via retroperitoneoscopy. In all cases a longitudinal incision approximately 1.5 cm. long was made with a potassium titanyl phosphate laser.Convalescence was uneventful in all patients and the endoureterotomy stent was removed 4 to 8 weeks after surgery. Postoperatively helical computerized tomography showed the successful transposition of crossing vessels and significant hydronephrosis resolution in all cases. All patients were asymptomatic during followup of 17 to 28 months.Despite our small number of patients our results are sufficient to conclude that retroperitoneoscopic pyelotomy combined with the transposition of crossing vessels is a simple and reliable method for treating ureterovascular hydronephrosis and associated conditions.

In order to elucidate whether T-2 toxin (T-2) and nivalenol (NIV), the naturally occurring trichothecene mycotoxins in food and feed, are carcinogenic or possess an ability to modulate aflatoxin B1 (AFB1)-induced hepatocarcinogenicity, a medium-term liver bioassay was carried out. F344 male rats were given a single i.p. injection of diethylnitrosamine (DEN, 200 mg/kg), and then fed the test trichothecenes in diet (2 and 5 p.p.m. T-2 or 6 p.p.m. NIV) for 6 weeks beginning 2 weeks after the injection. Some control groups received DEN alone. For synergism between AFB1 and the trichothecenes, DEN-initiated rats as above were given a single i.p. injection of AFB1 (0.5 mg/kg) 2 weeks later and were fed a NIV-containing diet (6 p.p.m.) for 6 weeks. The other control group received the vehicle alone. Control rats not initiated with DEN were also treated with AFB1, NIV or T-2 alone as above. All rats were subjected to a two-thirds partial hepatectomy (PH) at week 3 and killed at week 8, and liver sections were analyzed by glutathione S-transferase placental form (GST-P) expression. In rats that did not receive DEN, AFB1 alone enhanced both the numbers and areas of GST-P-positive foci as reported earlier, while NIV or T-2 alone induced no marked changes. In rats initiated with DEN, AFB1 caused a marked expression of GST-P, and thus the hepatocarcinogenicity of AFB1 was reconfirmed. The expression of GST-P foci in rats fed T-2 or NIV was found to be at background level, indicating that the hepatocarcinogenicity was not predicted for the trichothecene mycotoxins such as T-2 and NIV by this medium-term bioassay system. In the group initiated by DEN followed by AFB1, on the other hand, an elevation of both the numbers and areas of GST-P-positive foci was observed by the subsequent feeding of rats with NIV, and this elevation was statistically significant from the sum totals of individual data of AFB1 or NIV alone. From this evidence, it is predicted that NIV causes an enhancing effect on AFB1-induced hepatocarcinogenesis.

Purpose To evaluate restoration of the photoreceptor outer segment and visual outcomes in closed macular holes. Design Retrospective case series. Methods We retrospectively observed the reparative process of macular holes in 28 eyes one, three, and six months postoperatively using spectral-domain optical coherence tomography. We evaluated the reflective line at the junction between the photoreceptor inner and outer segment (IS/OS) and the best-corrected visual acuity (BCVA). Results The outer photoreceptor layer showed a foveal detachment, a disrupted IS/OS line, or both one month postoperatively. No eye had a continuous IS/OS line. These abnormalities were gradually restored at various levels. At six months, nine eyes had a normal outer photoreceptor layer, four eyes outer foveal defects with a continuous IS/OS line, 12 eyes a disrupted IS/OS line, and three eyes outer foveal defects with a disrupted IS/OS line. The mean BCVAs were significantly ( P = .017) lower in groups with a disrupted IS/OS line compared to groups with a continuous IS/OS line with or without outer foveal defects. Conclusions Macular hole closure is attained by bridge formation (foveal detachment) and the IS/OS line heals in varying degrees. The visual outcomes were significantly better in eyes with a continuous IS/OS line than in those with a disrupted IS/OS line.

The GAL4 gene positively regulating the expression of the gene cluster GAL7-GAL10-GAL1 in the yeast Saccharomyces cerevisiae was isolated for its ability to suppress a recessive mutation in that gene. When the isolated gene was incorporated into a multi-copy plasmid, the GAL cluster genes in the host chromosome partially escaped the normal control; a yeast that harbors the plasmid bearing the GAL4 gene synthesized the galactose-metabolizing enzymes encoded by the GAL cluster genes at a low but significant level in the absence of galactose. If the GAL7 gene was amplified along with GAL4 on the multi-copy plasmid, the constitutive synthesis of Gal-1-P uridylyl transferase encoded by GAL7 was further pronounced and the enzyme activity reached the level of the fully induced wild-type yeast. Such an escape synthesis of the GAL enzymes was not detected if GAL4 or both GAL4 and GAL7 were carried by a single-copy plasmid. The results suggest that the escape synthesis of GAL enzymes observed in the GAL4-amplified yeast was a consequence of overproduction of the GAL4 protein. The GAL80 gene negatively regulating the GAL cluster genes was also isolated, and when amplified together with GAL4, no escape synthesis of the GAL enzymes was observed, suggesting that the balanced synthesis of two regulatory proteins was essential to maintain the repressed state of the GAL cluster genes.

Parameters obtained with several procedures assessing cardiac function which are handy enough to be carried out almost routinely were studied on their correlativity to obvious changes in the clinical course and on the difference between following three groups healthy subjects, ischemic heart disease without signs of heart failure and overt ischemic heart failure. It was clearly shown that most of the non-failing ischemic subjects were in the status of the latent heart failure, the range of distribution of the parameters in the ischemic heart disease being between those in the healthy and ischemic heart failure. Among the procedures studied, the ear-piece dye-dilution method was the most useful in the sense that it reflected cardiac function as it was at the time of the examination, while some other indices such as P wave duration in ECG and Q-I interval were rather poor in variability in relation to the clinical course. Actually P wave duration remained unchanged often long after the complete disappearance of signs of heart failure.

22才の女で,胸部(下行)大動脈縮窄症と診断し,手術に成功した症例を報告する.患者は約2年前より両側の耳鳴り,心悸亢進及びめまいを自覚し始め,某医にて高血圧症として治療を受けたが効果なく, 36年5月北大第二内科にて大動脈縮窄症と診断された,上肢の高血圧,下肢の比較的の低血圧,左右の血圧差,心基部,頚動脈部及び背部の心血管雑音,心電図にて左室肥大,眼底KW II a度,腎血流量の減少,血管心臓造影にて胸部大動脈の狭窄を認め,北大第二外科にて狭窄部の切断,代用血管移植術を施行し,血圧の正常化,自覚症の消失をみるに至つた.諸種検査成績並びに組織像,特に内膜の肥厚,中膜の弾性線維の断裂及び走向の乱れ,肉芽組織の形成の有無,外膜及び血管の変化などの所見と臨床的経過及び文献的考察を合せて,本症の成因を後天性の血管炎と推定した.