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Background: It is known that patients on hemodialysis (HD) are prone to developing zinc deficiency due to removal of zinc by HD, inadequate dietary intake, and reduced gastrointestinal zinc absorption. However, the prevalence of zinc deficiency in patients on peritoneal dialysis (PD) has not been well established., Methods: Serum zinc levels were compared between 47 patients on PD and 47 patients on HD matched for age, sex, and duration of dialysis. A serum zinc level < 60 μg/dL was defined as clinical zinc deficiency and a level of 60-80 μg/dL as subclinical zinc deficiency. The prevalence of zinc deficiency and associated clinical factors were determined in both groups., Results: Clinical zinc deficiency was found in 59.6% of the PD group and 70.2% of the HD group ( p = 0.391). Subclinical zinc deficiency was found in 40.4% of the PD group and 29.8% of the HD group. Age, body mass index, and serum albumin level were identified as independent predictors of zinc deficiency in the PD group by multivariate analysis., Conclusions: A higher prevalence of clinical and subclinical zinc deficiency was found in patients on PD. The rates were comparable between patients on PD and those on HD after adjustment for confounding factors.

Background: We evaluated the erythropoietic effects of canagliflozin, a sodium-glucose cotransporter 2 inhibitor, in type 2 diabetes patients with anemia of chronic kidney disease. Methods: Nine diabetes patients were enrolled and administered 100 mg canagliflozin once a day for 12 weeks. The patients received fixed doses of conventional antidiabetic drugs and renin-angiotensin system inhibitors for 8 weeks before enrollment; these drugs were continued during the study. Endpoints were changes in erythropoiesis parameters, including erythrocyte and reticulocyte count, hemoglobin, hematocrit, and serum erythropoietin (EPO) concentration from baseline to 12 weeks. All variables were measured every 2 weeks. Results: Serum EPO concentration increased by 38 [15-62]% ( P  = 0.043) between baseline and 2 and 4 weeks. Reticulocyte count transiently increased at 2 weeks. Erythropoiesis occurred after 2 weeks of canagliflozin treatment. Erythrocyte count (from 386 ± 36 × 10 4 /μL to 421 ± 36 × 10 4 /μL; P  = 0.0009), hemoglobin (from 11.8 ± 0.6 g/dL to 12.9 ± 1.1 g/dL; P  = 0.0049), and hematocrit (from 37.1 ± 2.3% to 40.4 ± 3.2%; P  = 0.002) increased from baseline to study completion. Although there were no significant changes in transferrin saturation, serum ferritin levels were decreased ( P  = 0.003). Conclusions: Canagliflozin treatment led to an improvement in erythropoiesis in patients with impaired kidney function. The effect on erythropoiesis appeared to be due to an EPO production-mediated mechanism and might be independent of glycemic control; however, further studies are needed to clarify this since the present study had a small sample size and no comparator group.

Purpose: Filar cysts (FCs) are detected incidentally on ultrasonography (US) of the neonatal spine. Their clinical significance has not been widely discussed in the literature because FCs are usually asymptomatic. This study aimed to investigate the clinical features of FCs and distinguish FCs that warrant attention., Methods: We retrospectively analyzed 396 patients with lumbosacral skin stigmata. Patients who were younger than 1 month old at reference underwent US initially, and those older than 1 month of age underwent magnetic resonance imaging (MRI) at the age of 5-12 months. Patients with an FC in the US underwent subsequent MRI at the age of 5-12 months. Patients with an FC were followed clinically for at least 3 years., Results: FCs were identified in 56 (14.1%) patients. Of the 195 children who underwent US initially, FCs were detected in 49 (25.1%) children. FCs were detected in seven children who underwent MRI initially. Of the 50 children with FCs who underwent MRI at the age of 5-12 months, FCs in 20 patients (40%) showed natural regression and FCs in 30 patients (60%) remained. Two of these 30 patients showed progression in size of the FC, and in both cases, the FCs were associated with a filar lipoma; however, the resected cysts were not neoplastic and did not have obvious clinical significance., Conclusions: Our study characterizes clinical features of filar cysts. Two-thirds of FCs remained in late infancy. The best sequence of MRI to follow-up FCs is heavily T2-weighted images.

Background: The purpose of this study was to determine the correlation between aortic calcification and demographic and biochemical parameters in hemodialysis patients., Summary: Calcification scores of the aortic arch and abdominal aorta were determined from multi-slice computed tomography scans and evaluated according to the Agatston score. The associations between demographic and biochemical parameters and aortic calcification score were determined. In total, 190 patients were included in the study. There was a significant positive correlation between aortic calcification scores and age, duration of hemodialysis, cardiothoracic ratio, normalized protein catabolic rate, brachial-ankle pulse wave velocity (baPWV), serum markers of mineral metabolism, and inflammation. A significant negative correlation was found between aortic calcification scores and platelet count. Multivariate analysis showed that age, duration of hemodialysis, baPWV, phosphate, calcium and phosphate (Ca×P) product, parathyroid hormone, and C-reactive protein levels were independent risk factors for calcification of the aortic arch, while baPWV and Ca×P product were independent risk factors for calcification of the abdominal aorta. Key Messages: Aortic calcification scores correlate with age, duration of hemodialysis, and several biochemical parameters of inflammation and mineral metabolism., (© 2019 S. Karger AG, Basel.)

Introduction: Self-made devices composed of agar and gelatin gel were used for resident training in intra-axial brain tumor resection. The mixture gel of agar and gelatin is retractable and can be suctioned. Hardness of the gel depends on the concentration of the solution. Therefore, by changing the concentration, it is easy to make gels of various hardness., Methods: In this study, a mass of gel that looked like a tumor was placed into another gel that looked like the brain. A part of the "brain" was regarded as the eloquent area. Three types of "tumor" were prepared: hard, moderately hard, and soft tumors. Residents tried to remove the tumor entirely with minimal brain invasion. The training was repeated with 3 types of gel. After resection, the weight of the residual tumor, resected normal brain, and resected eloquent area were measured, and the time taken for removal was recorded., Results: These data were compared between residents and neurosurgeons. We also analyzed how these data improved with repeated practice. In most cases, residual tumor, resected normal brain, resected eloquent area, and time taken for removal were less in neurosurgeons than in residents. Repeated training made residents more skillful. The responses of the trainees were almost all favorable., Conclusions: Our devices with "tumors" of various hardness appear to be suitable for resident training in each surgical skill. For the next step of this study, we will attempt to fabricate more practical 3-dimensional gel models for presurgical simulation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Sophisticated tongue movements are coordinated finely via cortical control. We elucidated the cortical processes associated with voluntary tongue movement. Movement-related cortical fields were investigated during self-paced repetitive tongue protrusion. Surface tongue electromyograms were recorded to determine movement onset. To identify the location of the primary somatosensory cortex (S1), tongue somatosensory evoked fields were measured. The readiness fields (RFs) over both hemispheres began prior to movement onset and culminated in the motor fields (MFs) around movement onset. These signals were followed by transient movement evoked fields (MEFs) after movement onset. The MF and MEF peak latencies and magnitudes were not different between the hemispheres. The MF current sources were located in the precentral gyrus, suggesting they were located in the primary motor cortex (M1); this was contrary to the MEF sources, which were located in S1. We conclude that the RFs and MFs mainly reflect the cortical processes for the preparation and execution of tongue movement in the bilateral M1, without hemispheric dominance. Moreover, the MEFs may represent proprioceptive feedback from the tongue to bilateral S1. Such cortical processing related to the efferent and afferent information may aid in the coordination of sophisticated tongue movements., (Copyright © 2016 Elsevier Ireland Ltd and Japan Neuroscience Society. All rights reserved.)

We developed a method for manufacturing solid models of cerebral aneurysms, with a shorter printing time than that involved in conventional methods, using a compact 3D printer with acrylonitrile-butadiene-styrene(ABS)resin. We further investigated the application and utility of this printing system in emergency clipping surgery. A total of 16 patients diagnosed with acute subarachnoid hemorrhage resulting from cerebral aneurysm rupture were enrolled in the present study. Emergency clipping was performed on the day of hospitalization. Digital Imaging and Communication in Medicine(DICOM)data obtained from computed tomography angiography(CTA)scans were edited and converted to stereolithography(STL)file formats, followed by the production of 3D models of the cerebral aneurysm by using the 3D printer. The mean time from hospitalization to the commencement of surgery was 242 min, whereas the mean time required for manufacturing the 3D model was 67 min. The average cost of each 3D model was 194 Japanese Yen. The time required for manufacturing the 3D models shortened to approximately 1 hour with increasing experience of producing 3D models. Favorable impressions for the use of the 3D models in clipping were reported by almost all neurosurgeons included in this study. Although 3D printing is often considered to involve huge costs and long manufacturing time, the method used in the present study requires shorter time and lower costs than conventional methods for manufacturing 3D cerebral aneurysm models, thus making it suitable for use in emergency clipping.

In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

We report the case of a 59-year-old women with a cerebral arteriovenous malformation (AVM) in the right frontal lobe, which was detected incidentally. Additionally, an aneurysm was found at the feeding artery of the AVM. The patient was treated conservatively. Nine years later, the nidus of the AVM was no longer detectable. The angiography showed the associated aneurysm growing irregularly with a daughter sac. The spontaneous occlusion of an AVM and the following progression of an associated aneurysm are rare. The possible mechanisms leading to the occlusion of the AVM and the progression of the associated aneurysm are discussed., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

A patient who receives stereotactic radiosurgery(SRS)alone for treating the brain metastatic lesion has a risk of tumor recurrence in the brain. Thus, some patients undergo prophylactic whole brain radiotherapy(WBRT)in addition to the SRS. However, the usefulness of adding WBRT is still debatable. In our hospitals, we initially treat metastatic brain tumors with SRS alone, and have experienced 2 long-surviving cases. Here, we report our treatment outcomes, including those for these 2 cases, and discuss the treatment plan for non-small cell lung cancer(NSCLC)with brain metastases. Forty-two brain metastatic cases were studied. Median survival(MS), tumor control rate(TCR), and recurrence ratio at distant site(RRDS)in the brain were analyzed. Age, Karnofsky performance status(KPS), and recursive partitioning analysis(RPA)class were analyzed as prognostic factors. We present 2 cases of a 42- and a 56-year-old man, surviving for more than 100 months. MS, TCR, and RRDS at 1 year in our hospitals were 20 months, 89.1%, and 25.6%, respectively. The prognostic factors were good KPS and RPA class and younger age. Our data showed a good MS among some reliable random controlled trials. Our strategy of SRS alone preserves the possibility to treat new lesions with WBRT. Prognosis was mainly defined by the systemic condition of the patient and activity of the primary lesion. Thorough treatment of the primary lesion with addition of SRS for initial treatment of metastatic lesions and scheduled MRI follow-up will provide for longer survival times.

Purpose: This study aims to ascertain which specific types of sacrococcygeal dimples are associated with underlying spinal cord malformations., Methods: From 2008 to 2011, we prospectively examined children less than 2 years old with sacrococcygeal dimples. Each patient underwent clinical assessment of dimples and magnetic resonance imaging. We devised the following new classification of dimples according to their location: type 1, dimples located within the gluteal crease, including coccygeal pits; type 2, dimples located at the upper edge of the gluteal crease with associated curving or deformity of that crease; and type 3, dimples located well above the gluteal crease., Results: We evaluated 142 patients with sacrococcygeal dimples. Although we identified spinal malformations such as spinal lipomas, filum cysts, and thickened fila terminalia in only 17 % of infants with type 1 dimples, we observed them in 45 % with type 2 and 55 % with type 3. Thus, in terms of the rate of spinal malformations, there are significant differences between types 1 and 2 and between types 1 and 3., Conclusions: We propose a new classification of sacrococcygeal dimples. Although type 2 dimples have previously been classified as simple dimples that require no further investigation, we have identified that they are strongly associated with spinal deformities, comparable to atypical type 3 dimples. Thus, both types 2 and 3 dimples warrant radiological investigation.

Quadrilateral dural window is opened with a conventional incision design, such as a pair of diagonal lines or a rectangular shape, but the total cutting length is not the shortest possible. Shorter incision length will have a lower risk of dysraphia associated with cerebrospinal fluid (CSF) liquorrhea or related CSF infection. We propose a new and effective dural incision design with the shortest cutting length for quadrilateral dural openings. We investigated the design of the dural incision using a simple planar geometrical figure. We discovered the shortest network design to connect the four vertices of the quadrilateral. The shortest network design was formed of five line segments with two three-pronged interconnections (TPIs) with the same angle of 2π/3 between any two lines (2π/3-TPI). In practice, first we must draw a quadrilateral W horizontally then add two equilateral triangles outside W. Using a 2π/3-bent wire, the 2π/3-TPIs are traced on the path connecting the outward vertices of the equilateral triangles. Using this method, we can reduce the incision length by 10% from conventional designs using a pair of diagonal lines.

The absorption spectra of surface-scattered solar radiation were measured from the top of Mount Tsukuba (altitude 833 m) in the short wavelength infrared region using a Fourier transform spectrometer (FTS). The FTS used in this experiment was the breadboard model of the FTS on the Greenhouse Gases Observing Satellite, which was launched on 23 January 2009. In situ measurement of carbon dioxide (CO(2)) from a Cessna airplane was performed simultaneously with the FTS observation. The CO(2) column abundances were retrieved from the observed spectra under the assumption of the absence of aerosol. The retrieved CO(2) column abundances over a few minutes dispersed within 1%. The remaining bias was considered to be caused by the no-aerosol assumption.

Background/aims: To evaluate usefulness of esophagogastrectomy via left thoracoabdominal (LT) approach for adenocarcinoma of the esophagogastric junction (AEG), the results of surgery stratified by Siewert's classification, were analyzed retrospectively., Methodology: The tumor diameter, distance of the proximal tumor border from the esophagogastric junction, and length of the esophagus in the resected specimens of consecutive 171 AEG patients were measured. The surgical approach was classified as total esophagectomy (TE), esophagogastrectomy via LT, or transhiatal/abdominal (HA) approach., Results: Sixteen patients underwent TE, 71 had LT, and 84 had HA. Overall survival of the TE and LT groups was significantly lower than that of the HA group. The difference was seen between LT and HA for type II T3 tumors, but the tumor diameter in LT was significantly larger than that in HA. The approach could not be determined by Siewert's classification, but by distance of proximal tumor border from the junction. The tumors with distance over 5cm might be indicated for the TE approach; 5-3cm, the LT; within 3cm, the HA. The percentage of patients in whom the LT approach is indicated might be only 19%., Conclusion: Left thoracoabdominal esophagogastrectomy may be valid for some AEG.

Background: Crohn's disease and ulcerative colitis (UC) are the two main entities involved in human inflammatory bowel disease (IBD). However, their precise etiologies remain unclear. To study the development of mucosal inflammation, and chronic inflammation-based dysplasia and carcinoma formation, we examined possible roles of the apoptosis inhibitor expressed by macrophages (AIM) in an experimental IBD model., Methods: In this study, we used T cell receptor alpha deficient (TCRalpha(-/-)) mice, a known UC-like colitis model. We generated TCRalpha(-/-) x AIM(-/-) double knockout mice by crossbreeding TCRalpha(-/-) with AIM(-/-) mice. At 24 weeks of age, mice were killed to obtain colon tissues for pathological examinations. TCRalpha(-/-) x AIM(+/-) mice, heterozygous littermates of TCRalpha(-/-) x AIM(-/-) mice, were used as controls., Results: Severe colitis was observed in TCRalpha(-/-) x AIM(-/-) mice, when compared with TCRalpha(-/-) x AIM(+/-) mice. Dysplasia was detected in TCRalpha(-/-) x AIM(-/-) mice, but not in TCRalpha(-/-) x AIM(+/-) mice. Adenocarcinoma formation was observed from dysplasia only in TCRalpha(-/-) x AIM(-/-) mice., Conclusion: Not only a high incidence of severe colitis but also dysplasia and adenocarcinoma formation were observed in TCRalpha(-/-) x AIM(-/-) mice only. AIM have some regulatory roles in inflammation and progression of dysplasia to carcinoma in TCRalpha(-/-) mice.

The relationship between alder (Alnus japonica) distribution and surrounding land use in Kushiro Mire was spatially assessed using remotely sensed imagery. From the result, it was found out that the expanding area of alder trees in Kushiro Mire was affected by the agricultural land area in the upper course of the river basin and flooding in the lower course of the river. The soil sediments flowing into the Kushiro Mire from the agricultural land resulted in heavy sedimentation that favors the growth of alder trees. Consequently, the number and density of alder trees has increased. The future distribution of alder trees was predicted based on the mechanism of expansion of the alder-tree area in Kushiro Mire, and it was found that large vegetation areas in Kushiro Mire will be changed to areas with alder trees.

Morphometric data were obtained from fresh cadaver dissections, and observations of degenerative changes in the joint cartilage (DCs) were analyzed to determine whether the morphometric parameters of the lumbar zygapophyseal joint capsule varied according to the presence and severity of DCs. There have been no previous morphometric studies of the facet capsule that describe age-related DCs. Using 23 fresh osteoligamentous lumbar spines from donated cadavers, we performed morphometric investigations of the surface areas of the joints and their capsules and measured the capsular thickness. We hypothesized that the ratio of the inner capsular area to the joint surface area for each facet (the capsule/facet index) could serve as an index showing a functional aspect of a large or small capsule. Our results showed that the joint surface area increased significantly with increasing severity of DCs, according to Grogan's classification. Facets with advanced DCs tended to have a small inner capsular surface. The capsule/facet index generally correlated positively with capsular thickness, especially the dorsal portion; however, this was not true for the ventral portion. The index also correlated negatively with DC progression. Thus, lumbar facet DCs were strongly linked to reconstructive alterations in capsular size, thickness, and looseness. The occurrence and progression of DCs narrowed the joint capsule, especially the dorsal portion, and this seemed to decrease the potential looseness of the joint. Conversely, these capsular alterations seemed to accelerate DC progression. A negative adaptation cycle seemed to occur.

Using 10 osteoligamentous vertebral columns obtained from elderly donated cadavers, we describe in detail degenerative changes of the articular cartilage in lumbar zygapophysial joints to show which portion in a facet is specifically affected. Degenerative changes, including extended cartilage defects, occurred in multiple facets of every specimen. The results demonstrated 5 basic morphologies of degeneration, i.e., 1) marginal dominace in the articular surface, 2) lower segment dominance except for the lowest (L5/S) facet, 3) advancement in the inferior articular process, 4) cranial and caudal dominance rather than the dorsal dominance in the articular surface and 5) progress in a mirror-image manner. These rules seemed to be consistent with differences in size, shape and kinesiological aspects of the facet between segments and between portions in a facet.

Background: Micrometastasis to the bone marrow can predict widespread disease and a poor prognosis of cancer patients after surgery. The purpose of this study was to evaluate the clinical significance of detecting micrometastasis in the bone marrow of gastric cancer patients., Methods: Bone marrow and peripheral blood samples were obtained from 53 gastric cancer patients at the time of surgery. These samples were enriched by immunomagnetic separation and immunostained with an anti-cytokeratin antibody. Expression of vascular endothelial growth factor and erbB-2/HER2 was examined in the primary tumors., Results: Cytokeratin-positive cancer cells were observed in the bone marrow of 16 (30%) of 53 patients. Among them, two patients also had cancer cells in the peripheral blood. The presence of bone marrow micrometastasis was correlated with the depth of invasion and lymph node metastasis but was not associated with peritoneal dissemination. Detection of bone marrow micrometastasis was not correlated with vascular endothelial growth factor or HER2 expression in the primary tumors. Four patients with micrometastasis had recurrence in the liver or lungs, but this did not occur in patients without micrometastasis., Conclusions: Detection of cancer cells in the bone marrow might be an indicator of postoperative hematogenous metastasis in gastric cancer patients.

The prognosis for patients with advanced gastric cancer remains poor. Peritoneal metastasis is the most frequent cause of death in patients with gastric cancer, but the most appropriate treatment for patients with disseminated gastric cancer remains uncertain. S-1 is a newly developed oral fluoropyrimidine derivative with unusually high activity against several tumor types. The aim of this study was to evaluate the feasibility and efficacy of S-1 for the treatment of patients with disseminated gastric cancer. A total of 31 patients with primary or recurrent gastric cancer with peritoneal dissemination were entered into this study. One course of this single-drug therapy consisted of S-1 (80-120 mg) twice daily for 28 days, followed by a 2-week period of no treatment. These treatments were repeated until disease progression or patient refusal. With a median follow-up period in survivors of 293 days, the median survival time was 357 days. Toxicities were mild and no patient withdrew from treatment before disease progression. Grade 3 hematotoxicity was observed in only one patient. S-1 showed promising activity against gastric cancer with peritoneal dissemination and acceptable toxicity. Further evaluation of S-1 treatment is warranted in this disease.

Using 26 osteoligamentous lumbar vertebral columns (260 facets), we morphometrically investigated the cartilagenous joint surface, inner capsular surface and capsular thickness. We also examined whether the subcapsular pocket was present and, if present, how far it extended along the joint margin. The proportion of the inner capsular area in the total joint surface area in a facet (the capsular-joint surface ratio) was hypothesized to correspond to the potential looseness (or tightness) of the facet. The absolute data themselves seemed to be useful for better understanding of the joint morphology. However, further evaluations of the differences between segments, left/right differences, individual segmental fluctuation patterns and correlations between parameters provided a novel classification of specimens according to the hypothetical progress of joint degeneration. Criteria for the classification existed in 1) the laterality in parameters defined as more than 100% larger or smaller than the contralateral facet and 2) the drastic segmental difference in parameters over 50% larger or smaller than the adjacent segment. Consequently, three types were identified: 1) outside of the criteria in both area and thickness (-/- type, 9 of 26); 2) the criteria did not fit the area parameters but did fit the thickness parameters (-/+ type, 8); the criteria were filled in both categories of parameters (+/+ type, 9). Notably, in the +/+ types, the capsular thickness and capsular-joint surface ratio correlated significantly (p < 0.01), i.e., the hypothetical loose joint had a thick capsule. We speculated that early joint degeneration starts from the -/- type and advances via the -/+ type to the +/+ type. Considerating these results, we recommended using MR imaging for detailed identification of laterality in the capsular thickness for low-back pain patients to discriminate candidates for future severe degenerative changes of the articular cartilage in the lumbar spine.

The purpose of this histologic study was to identify the most effective bony surface for fibrous connection to bone after immediate repair of the canine infraspinatus. Light microscopic views were used to evaluate collagen fiber development. The left infraspinatus tendon of 15 dogs was transected and repaired to 3 different bone surfaces: a tendon end adjacent to the tendon insertion (group 1, n = 5), a calcified fibrocartilage layer (group 2, n = 5), and a cancellous surface (group 3, n = 5). Tendon repair to distal tendon ends restored the 4-layered enthesis in the healing period, whereas tendon repair to the calcified fibrocartilage layer considerably delayed fiber development into bone. Fiber connection to cancellous surface developed according to the remodeling of trabecular bone. Secure fiber connection into the thickened trabecular bone developed by 16 postoperative weeks. On the basis of these results, in clinical settings, ruptured tendon ends should be attached to the remaining distal tendon end or to a cancellous surface; they should not be attached to a calcified fibrocartilage layer.

In order to select the most appropriate treatment for gastric cancer in the cardiac area, precise staging by determining the depth of cancer invasion, and esophageal invasion, and lymph node metastases is important. In this paper, diagnosis of these factors using endoscopic ultrasonography (EUS) and its accuracy are discussed. In 121 cases of gastric cancer in the cardiac area, EUS was performed and the findings compared with the pathological diagnosis. The depth of cancer invasion was accurately determined in 60% of mucosal cancer cases, 83% of cancer invading the submucosa, 50% of cancer invading the muscularis propria or the subserosa, 86% of cancer invading the serosa, 45% of cancer invading other organs, and overall accuracy was 77%. In cases of esophageal invasion sensitivity was 98%, specificity 93%, and overall accuracy 94%. In cases of lymph node metastasis specificity was 78%: 86% for N1 and 72% for N2. EUS therefore has an important role in diagnosis and selection of treatment.

Large quantities of Prevotella nigrescens (intermedia) ATCC 25261 (P. nigrescens) cells adhere to hydroxyapatite (HA) treated with citrate, but do not adhere experimental pellicle prepared from human whole saliva. To determine the nature of the citrate responsible for promoting P. nigrescens cell adhesion, the duration and frequency of citrate treatment of HA and the inhibitory effect of other carboxylates were tested. The citrate rapidly adhered to HA beads in less than 15 min. With a lower concentration (0.4 mM) of citrate, four treatments of HA were required to promote the maximum adherence to P. nigrescens cells. Citrate-enhanced P. nigrescens cell adherence to HA beads was also inhibited in the presence of cis-aconitate, oxaloacetate and oxalsuccinate. It was also found that P. nigrescens cells heated to 65 degrees C or higher for 5 min could no longer become attached to citrate-treated HA. These data suggest that citrate is one of the essential factors responsible for P. nigrescens cell attachment to apatitic surfaces, and that P. nigrescens' adhesion to citrate is extremely heat-sensitive.

Two cases of postinfarction oozing type left ventricular rupture and a case of oozing type left ventricular rupture due to catheter perforation for left ventriculography are reported. The technique used to repair the rupture is fibrin glue-oxycellulose fixation method. The post operative course of three cases were uneventful. But left ventricular aneurysm remained in two cases.

A 70-year-old man complained left supraclavicular pulsatile tumor. Angiography and CT revealed the left subclavian arterial aneurysm that was just behind the clavicle. The aneurysm was resected through a cross-clavicle incision and an 8 mm Hemashield graft was implanted. The pathological study showed change of fibromuscular dysplasia. The post-operative course was uneventful.

Oral tissues, especially tooth surfaces, are covered with a layer of salivary proteins. Oral bacterial cells that adsorb to salivary components accumulated on the tooth surface are, as a rule, covered with the same components, especially proteins. Thus, it is possible that the salivary proteins covering the bacterial cells are related to the adhesion of bacteria to oral tissues. The aim of this study was to clarify the mechanisms of adsorption of salivary proteins to the surface of Streptococcus sanguis, S. mitis and S. salivarius using an adsorption assay with salivary proteins labeled with tritiated formaldehyde. The results showed that salivary proteins adsorbed more to S. salivarius than to S. mitis, and least to S. sanguis. It was evident that hydrophobic bonding was involved in the adsorption of salivary proteins to the bacterial cells tested. The amount of salivary proteins adsorbed to S. mitis and S. salivarius was decreased by the presence of phosphate, that to S. sanguis was increased by the presence of a divalent cation such as Ca2+, and that to all bacteria tested was inhibited in different ways by the presence of sugars. The amount of salivary proteins adsorbed to S. sanguis and S. salivarius was reduced effectively by pretreatment of the cells with trypsin, chymotrypsin and papain. In the case of S. mitis, the amount of adsorbed salivary proteins was decreased by pretreatment of the cells with chymotrypsin only, and was increased by pretreatment with lipase. These results indicate that there are different mechanisms of adsorption of salivary protein to the cell surfaces of oral streptococci.