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The present study uses structural equation modeling to explore the structural relationship of child behavior type and its evaluation during dental treatment. The study population consisted of 33 children at their first visit to a pediatric dentist at the Dental Hospital of Tsurumi University. Child behavior was evaluated by the Frankl Behavior Rating Scale and the behavior evaluation scale developed by Kurosu. Factor analysis extracted 3 behavior types: escape, self-defense, and facial expression. The path diagram of structural relationships between child behavior and the Frankl Behavior Rating Scale indicated that facial expression had the strongest correlation to the Frankl Behavior Rating Scale.

Histological abnormalities of the atherosclerotic lesion are closely related to the stability of the plaque. Specifically, the plaque is likely to be unstable if the fibrous cap is thin. However, ultrasonic characterization of the atherosclerotic lesion has not been done from this viewpoint. Thus, in the present study ultrasonic tissue characterization of the carotid atherosclerotic lesion was attempted to assess the stability of the plaque. Integrated ultrasonic backscatter (IBS) in the atherosclerotic lesion was compared with histological findings of the respective tissue in 35 patients with carotid artery stenosis who underwent carotid endarterectomy. Carotid IBS was determined by locating the region-of-interest (ROI) in the center of the atherosclerotic lesion and calibrating by subtracting the IBS in the tunica externa of the vessel from the IBS of the ROI. IBS was also determined at the interface of the plaque, and at this site it was analyzed in relation to the thickness of the fibrous cap. Lipid content, fibrous tissue, thrombus, hemorrhage and calcification were histologically assessed in the respective tissue. Carotid IBS in the lipid lesion (-22.5+/-4.1 dB) was significantly different from that of fibrous, hemorrhagic or calcified lesions (-11.1+/-7.1, -27.5+/-4.1, +2.1+/-6.5 dB, respectively), but there was no significant difference in IBS between the lipid lesion and thrombus (-15.2+/-8.8 dB). IBS was lower in the thin fibrous cap than in the thick lesion (-10.9+/-6.4 vs -2.4+/-6.2 dB, p<0.001). IBS can be used to characterize atherosclerotic lesions in the carotid artery; a low value at the interface suggests a thin fibrous cap, which is frequently associated with unstable plaque.

Endoscopic transthoracic sympathectomy (ETS) is an efficient, safe, minimally invasive procedure, and requires only a short period of hospitalization. We performed bilateral ETS using a thoracoscope 2 mm in diameter. We performed 120 ETS for the treatment of palmar hyperhidrosis from August 1997 to April 2000. The patient was placed in the semi-sitting position under general anesthesia, one-lung ventilation being used; the operation was performed with 2-mm two-puncture method. The sympathetic chain could be observed through parietal pleura riding on the costovertebral junctions. A 2-mm Kirschner wire was employed as an electrode, and the second and third thoracic sympathetic chains were electro cauterized. A thoracic drain was not used. The needling sites were only 2 mm in size and could be fixed without suture. For the patient, a small scar of this size means virtually no scar. The operative times were from 11 min to 81 min in bilateral ETS. Immediately and dramatic decrease in the sweat excretion in the palms was noted in all patients. The 95% patients were highly satisfied with the results. The commonest side effects were compensatory sweating. This procedure is recommended as the method of choice for the surgical treatments of palmar hyperhidrosis.

A mode of action study of herbicidal diphenylpyrrolidinones was carried out through carotenoid analyses in intact Scenedesmus cells and by a cell-free plant-type phytoene desaturase assay using Escherichia coli transformants. A series of forty-eight diphenylpyrrolidinones decreased the carotenoid content of Scenedesmus cells in the light and inhibited phytoene desaturase. The relationship between substituents at various positions and inhibition of phytoene desaturase is discussed. Using very active bleaching diphenylpyrrolidinones, a 10(-5) M concentration affected neither the zeta-carotene desaturase nor the protoporphyrinogen-IX oxidase. Although some differences in their inhibitory activity were found between the in vivo and cell-free assays, it is concluded that the compounds are essentially bleachers affecting carotenoid biosynthesis in plants. Enzyme kinetics studies with recombinant phytoene desaturase revealed a non-competitive inhibition with respect to the substrate phytoene. A competition against the inhibitor was shown by the cofactor NADP+, suggesting an interaction of pyrrolidinones at the cofactor-binding site of phytoene desaturase.

Nine hundred and seventy-three consecutive patients were referred to our hospital for thoracotomy to treat chest diseases between January 1, 1981, and December 31, 1995. Of these patients, 20 males were readmitted within a mean of 20 months with a diagnosis of contralateral pneumothorax. Sixteen of the patients with a mean age of 28.5 years (range 16-76 years of age) had been operated on for bullous lung disease. The remaining four, with a mean age of 60.8 years (range 54-71), had been operated on for lung cancer. All of the 20 patients had received unilateral thoracotomy for lung resection. One patient had undergone pneumonectomy for lung cancer; three had undergone lobectomy; and 16 had been treated by partial lung resection. The patient who had undergone pneumonectomy was found to have contralateral pulmonary metastasis of lung cancer. In the other 19 patients, emphysematous bulla was the origin of the contralateral pneumothorax. The mean value of body mass index (BMI) of the group was 18.4 as compared to 21.7 in the patients who did not go on to develop contralateral pneumothorax, a significant difference (p < 0.05). In conclusion, postoperative contralateral pneumothorax was correlated to the existence of emphysematous changes of the lung and a significantly lower BMI. We conclude that patients with BMIs less than 20 may be at increased risk of developing postoperative contralateral pneumothorax.

The presence of a horseshoe kidney associated with aortoiliac vascular disease poses technical difficulties in terms of vascular reconstruction. The renal isthmus, position of the renal pelvis and ureters, and variable blood supply to the horseshoe kidney can complicate aortoiliac reconstruction. The left retroperitoneal approach provides excellent exposure of the abdominal aorta in patients with a horseshoe kidney without dividing the renal isthmus and avoids the risk of injury to a ureter in an anomalous position. We herein report the case of a patient with a horseshoe kidney who underwent a successful reconstruction of aortoiliac vascular disease using the left retroperitoneal approach.

To evaluate the influence of coronary artery disease (CAD), we reviewed 102 patients who underwent elective repair of abdominal aortic aneurysm (AAA) between 1982 and 1992. Prior to surgery, all patients underwent clinical evaluation for the presence of CAD including dipyridamole thallium scintigraphy. They were classified into the following groups: Group I (n = 66), no clinical evidence of CAD; Group II (n = 26), clinical evidence of stable CAD; Group III (n = 10), unstable CAD. Coronary angiography (CAG) was performed in group II and group III patients only. All patients in group I and group II underwent elective repair of their AAA without coronary revascularization. Eight patients in group III underwent CABG followed by elective AAA repair within two months. One of two patients who had impending ruptured AAA underwent combined CABG and AAA repair as a single operation and the other underwent AAA repair followed by CABG. One case of perioperative myocardial infarction occurred in group II, but there was no early postoperative death related to cardiac disease in group I and II. In group III, however one patient who underwent combined surgery died of low-output syndrome in the early postoperative period, no death or myocardial infarction occurred following staged operation in the other nine patients. This present results support the contention that CAG is not necessary in all AAA patients, and that they can be managed according to appropriate risk by a selective approach based upon clinical assessment of their CAD. It is also apparent that a staged operation can be performed very safely in patients with unstable CAD.

Background: To achieve successful lung transplantation, it is essential to minimize reperfusion injury occurring as a result of metabolite accumulation during the preservation period or at the time of initial interaction of blood with constricted pulmonary vasculature. Initial reperfusion with warm crystalloid solution may be advantageous in preventing this injury., Methods: This study was designed to evaluate the effect of low-potassium (4 mmol/L) dextran (1%) solution as the initial warming solution after 6 hours of hypothermic storage. In 23 New Zealand White rabbits the lungs were flushed with low-potassium dextran solution (10 degrees C, 40 ml/kg, 600 cm H2O), excised, inflated with room air, and stored in a low-potassium dextran solution (10 degrees C) for 6 hours. After storage, the lungs were divided into two groups. Group 1 (n = 8) was reperfused with warm low potassium dextran for 4 minutes, at 37 degrees C followed by blood reperfusion for 30 minutes at 37 degrees C. Group II (n = 15) was reperfused only with blood for 30 minutes at 37 C. The mean pulmonary vascular resistance measured during cold flush and prior to storage was similar in both groups (group I = 20.0 +/- 5.9 mm Hg.sec/ml, group II = 19.3 +/- 1.9 mm Hg.sec/ml)., Results: During reperfusion, only 4 of the 15 lungs in group II maintained an acceptable (< 80 mm Hg) mean pulmonary artery pressure; six failed immediately. All eight lungs in group I completed the 30-minute reperfusion (p < 0.005). The mean pulmonary artery pressure was significantly less, and effluent oxygen tension was significantly greater in group I during reperfusion., Conclusions: In this experimental model, initial warm reperfusion with low-potassium dextran ameliorated the deleterious effects of reperfusion, thus providing an environment to improve lung preservation.

A rapid and significant vasodepressor effect was obtained during acute stage before and after surgery on aortic aneurysm with continuous antihypertensive therapy using nicardipine hydrochloride. Twenty patients were treated; 6 patients had an acute dissecting aneurysm of the aorta, 8 were postoperative cases following resection of the thoracic aortic aneurysm, and 6 were postoperative cases of the abdominal aortic aneurysm. Nicardipine hydrochloride is easy to administer, has few side effects, and was found to be effective as antihypertensive therapy before and after surgery. The use of nicardipine hydrochloride has therefore been adopted by this unit as part of the treatment protocol for these patients.

Background: The goal of organ preservation is maintenance of physiologic functions during extended extracorporeal storage., Methods: This study was designed to evaluate the efficacy of using low-potassium (4 mmol/L) dextran (1%) solution on lung function after 30 hours hypothermic (10 degrees C) storage and to compare this with lung function after no storage. With low-potassium dextran solution rabbit lungs were flushed (10 degrees C, 40 ml/kg, 60 cm H2O), excised, inflated (with room air), and either not stored (control; no preservation; n = 9) or stored in low-potassium dextran solution (10 degrees C) 30 hours (experimental group; n = 9)., Results: During the flush the infusion pressure and pulmonary vascular resistance for the two groups did not differ (17.56 +/- 1.3 versus 16.74 +/- 1.5 mm Hg/ml/sec). After either no preservation or after 30 hours of storage, the lungs were first reperfused with low-potassium dextran solution (37 degrees C) for 4 minutes and then with blood (37 degrees C) for 30 minutes at 100 ml/min. During the reperfusion period the mean pulmonary artery pressure and end-inspiratory airway pressure for the control and experimental groups did not differ. After reperfusion the wet and dry weights of the left lung were determined. The wet/dry ratio for the two groups did not differ (5.32 +/- 2.20 versus 4.70 +/- 2.70, respectively)., Conclusions: These data suggest that cold flush, cold storage, and initial warm perfusion with low-potassium dextran solution crystalloid preserve lung function after 30 hours of storage.

A case of mediastinal cavernous hemangioma was reported. An asymptomatic 6-year-old girl was discovered to have a mass in the left anterior superior mediastinum on a routine chest x-ray film. Computed tomograms demonstrated a mediastinal mass with calcification. Under a median sternotomy, a 10 x 9 x 5 cm mass was resected after dissecting the connections to the pericardium. As the mass surrounded the left phrenic nerve, the nerve was resected with the tumor. The histopathology was cavernous hemangioma. The calcification was not found in the vessels as the phleboliths but was showed in the interstitial tissues.

Esophageal duplication cyst associated with pericardial defect in a 57-year-old man is reported. Differential diagnosis was very difficult in the preoperative examination. The tumor was a cyst and its wall was a perfect replica of normal esophagus e.g. esophageal duplication, and total left pericardial defect also was found at the operation. There was no malignant or inflammation findings in the excised specimens. The association of esophageal duplication cyst associated with pericardial defect is very rare.

Migrated intra-cardiovascular fragments from broken catheters were retrieved transvenously in 6 cases. In all of these cases, the catheters had been used for total parenteral nutrition. The catheter fragments were lodged in the pulmonary artery in 3 cases and in the right atrium in the others. A basket-type grasping forceps modified for this retrieval technique was inserted via the subclavian vein, femoral vein or basilic vein percutaneously. The migrated catheter fragments were removed successfully without any clinical complications in all 6 cases. Appropriate evaluation of the lodging site and length of the fragment, and careful examination of general condition should be carried out prior to this procedure. This noninvasive maneuver is simple, safe and reliable, and can be promptly. It is considered to be a reliable method of choice in cases of migrated catheter fragment.