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Background Alagille syndrome is a multisystem disorder, which is characterized by hypoplasia of the intrahepatic bile ducts, malformations of the cardiovascular system, eyes, and vertebral column, and abnormal facies. Several of the characteristics of Alagille syndrome may result in an especially high risk of fracture. The majority of patients suffer from chronic cholestasis, which can have a variety of adverse effects on bone metabolism. In Alagille syndrome, fractures primarily occur in the lower limb long bones in the absence of significant trauma. Case presentation A 9-year-old Japanese girl with Alagille syndrome was admitted to our institution with marked hyperbilirubinemia and a pathological fracture of the femur. She had been diagnosed with biliary atresia at the age of 1 month and treated with surgical bile duct reconstruction, vitamins D and K, and ursodeoxycholic acid. However, her liver dysfunction and hyperbilirubinemia worsened. The pathological fracture of the femur was treated with low-intensity pulsed ultrasound stimulation (LIPUS) and an Ilizarov ring fixator. Seventy-four days after surgery, the patient had anatomically and functionally recovered. There was no leg-length discrepancy and no angular malalignment of the lower extremities as measured clinically and radiographically. The range of motion of the hip, knee, and ankle of the patient’s operative leg matched the range of motion in the nonoperative leg. Conclusion To the best of our knowledge, there are no reports on use of the Ilizarov frame and LIPUS in diaphyseal femoral fractures in Alagille syndrome. This case report provides evidence that this procedure is successful for managing such diaphyseal fractures in Alagille syndrome.

Rapidly destructive coxarthrosis (RDC) is known to affect elderly women, but its etiology is unknown. This is the first report to our knowledge, based on a search of the English literature, that reveals the entire process of hip destruction from the onset to the terminal stage of RDC, in an 80-year-old woman. Radiographic evaluation showed subchondral insufficiency fracture of the femoral head at an early stage of this disease. An MRI examination within a month of the onset of hip pain showed the entire femoral head with low intensity on T1-weighted images and high intensity on T2-weighted images, and a small low-intensity band at the subchondral area of the lateral weight-bearing portion of the head. These findings are consistent with subchondral insufficiency fracture and associated bone marrow edema. The lesion developed into a deep and large erosion at the superolateral portion of the femoral head, the process being observed on both roentgenograms and MRI. These findings were confirmed during total hip arthroplasty. This case suggests that subchondral insufficiency fracture of the femoral head may be a preceding sign of destruction of the femoral head.

We studied the range of shoulder motion of patients who underwent vertical as compared with horizontal capsulotomies during open Bankart repair for recurrent anterior dislocations of the shoulder. A vertical capsulotomy was used in 10 shoulders and a horizontal capsulotomy was used in 14 shoulders. Except for the method of capsulotomy, the surgical procedure and postoperative rehabilitation were the same. The range of motion was measured at 1.5, 2, 3, 4, 5, 6, 9, and 12 months after the surgery, and at the final follow-up (average, 49 months for the vertical and 26 months for the horizontal group). No dislocations recurred, and the anterior apprehension test was negative in all of the patients in both groups. External rotation in abduction was greater in the horizontal group than in the vertical group; the differences were significantly greater at 9 months and 12 months after surgery and at the final follow-up. External rotation in adduction, flexion, and internal rotation were not significantly different between the groups. We conclude that Bankart repair through a horizontal capsulotomy preserves a better range of external rotation in abduction than does a vertical approach.

PURPOSE We report the clinical results and efficacy of laparoscopic radical prostatectomy for localized prostate cancer. PATIENTS AND METHODS Between December, 1999 and June, 2000 we performed transperitoneal laparoscopic radial prostatectomy on 10 patients with T1 or T2 organ confined prostate cancer according to the techniques as described by Guillonneau et al. Different points were as follows: 1) We placed double J catheters during surgery to prevent ureteral injury. 2) We treated dorsal vein complex using an Endo-GIA-stapler. 3) We dissected the bladder neck from the prostate using an ultrasound scalpel in the manner to preserve the bladder neck. RESULT We could not completed laparoscopic prostatectomy on two patients because of massive bleeding from dorsal vein and consuming too much time to suture urethra-bladder anastomosis. The average operating time in all cases was 8.1 hours including 1.8 hours in laparoscopic pelvic lymphadenectomy. The average estimated blood loss in all cases was 859 ml. There were 2 surgical complications with bladder injury and port site hernia. The histological examination revealed prostate cancer; pT2pNO in 8, pT3pNO in 2. The surgical margin and lymph nodes were negative in all patients. The duration of an indwelling catheter ranged from 5 to 40 days mean 17 days. The duration to recovery of normal micturition was 6 to 90 days, mean 40 days. CONCLUSION Long-term follow-up and extensive studies are necessary to evaluate the efficacy of this procedure. It might provide shorter duration of an indwelling catheter and earlier recovery of normal micturition as compared with the conventional open surgery.

The effects of halothane, isoflurane, sevoflurane (0.5, 1 and 2 MAC) and pentobarbital (10(-5) M, 10(-4) M and 3 x 10(-4) M) on hypocapnia- and bicarbonate-induced constriction of isolated dog middle cerebral arteries were investigated in vitro. The isometric tension of isolated cerebral arterial rings was measured in an organ bath containing Krebs bicarbonate solution, aerated with 5% CO2 and 95% O2. Hypocapnia, induced by replacing the bathing solution with one that had been equilibrated with 2.5% CO2 and 97.5% O2, produced a sustained vasoconstriction (268 +/- 36 mg, mean +/- SEM). Exposure of arterial rings to a bathing solution that contained double the concentration of NaHCO3 (50 mM) elicited a phasic constriction followed by a gradual decrease in tension (309 +/- 34 mg). Although halothane, isoflurane, and sevoflurane attenuated both hypocapnia- and bicarbonate-induced constrictions in a dose-dependent manner, the inhibition of these constrictions was greater in rings treated with halothane than in those treated with isoflurane or sevoflurane when compared at equipotent concentrations. These alkaline-induced constrictions were attenuated by pentobarbital only at the highest concentration of 3 x 10(-4) M. Halothane (1 and 2 MAC) attenuated the constriction induced by hypocapnia to a greater extent than that induced by 15 mM KCl, whereas pentobarbital (10(-4) M and 3 x 10(-4) M) attenuated hypocapnia-induced constriction less than KCl-induced constriction. These results indicate that alkaline-induced constriction is more vulnerable to halothane than other volatile anesthetics and pentobarbital. The mechanisms of the inhibitory effects of halothane and pentobarbital on alkaline-induced cerebral vasoconstriction seem to differ; the inhibitory effect of pentobarbital, but not of halothane may be, in part, ascribed to its inhibitory effect on the Ca++ influx.

A 71-year-old Japanese female Nagasaki-atomic-bomb survivor was admitted for evaluation of a mediastinal mass. She was infected with human T-cell leukemia virus type I. Histological examination of the biopsy specimen, obtained thoracoscopically from the mass, revealed amyloid lymphadenopathy confirmed by Congo-red staining and electron-microscopic examination. Amyloid deposits and the serum monoclonal peak consisted of immunoglobulin λ light chains. No atypical cells were detected in bone marrow. The case was diagnosed as an unusual amyloidosis affecting the mediastinal lymph node. No other sites were found to be affected by amyloidosis, although systemic involvement could not be conclusively ruled out.(Internal Medicine 39: 839-842, 2000)

Objectives. To evaluate the efficacy of laparoscopic radical nephrectomy for patients with small renal cell carcinoma by comparing the clinical results of patients treated laparoscopically with those of patients treated with traditional open radical nephrectomy. Methods. Of 100 patients with localized, small (less than 5 cm in diameter) renal cell carcinoma treated by the same surgical team between 1992 and 1998, 60 patients underwent laparoscopic radical nephrectomy and 40 underwent open radical nephrectomy. Of the 60 laparoscopically treated patients, the first 11 and the most recent 34 patients were operated on transperitoneally and the other 15 retroperitoneally. Results. The mean operative time of the laparoscopically treated patients was longer than that of the open nephrectomy patients (5.2 versus 3.3 hours, P < 0.001). The mean blood loss of the laparoscopically treated patients was less than that of the open nephrectomy patients (255 versus 512 mL, P < 0.001). One laparoscopically treated patient needed conversion to open surgery. The time to full convalescence of the laparoscopically treated patients was shorter than that of the open nephrectomy patients (23 versus 57 days, P < 0.001). Two of the 59 laparoscopically treated patients and 1 of the 40 open nephrectomy patients had metastatic disease. The former 2 are alive with stable disease and the latter died of progressive disease 11 months after surgery. The 5-year disease-free rate was 95.5% in laparoscopy patients and 97.5% in open nephrectomy patients (P = NS). Conclusions. Laparoscopic radical nephrectomy is a less invasive alternative to open surgery for patients with localized small renal cell carcinoma.

Perforation of ulcer of the reconstructed gastric tube to vessels after operation for esophageal cancer is so rate that only two cases have been reported in Japan. We have experienced a case of perforated ulcer of reconstructed gastric tube to the left subclavian artery causing massive hematemesis. This paper presents the case with some bibliographical comments. A 58-year-old man was admitted to the hospital because of hematemesis. Previous histories disclosed that he underwent a right thoracolaparotomic subtotal esophagectomy and retrosternal esophagogastroanastomosis for a cancer of the middle intrathoracic esophagus in August, 1992; and he had been healthy for 5 years and 11 months after postoperative irradiation until this admission. The patient repeated massive hematemesis and fell in shock state. An emergency operation was performed. When the gastric tube was examined under a median sternotomy, arterial projective bleeding from a small ulcer just beneath the esophagogastoanastomosed site was confirmed. Hemostasis of the bleeding site was attained by simple suture, the reconstructed tube was pulled out, and an esophagostomy and a jejunostomy were performed. Postoperative angiography demonstrated that the perforated organ by ulcer of the reconstructed gastric tube was the left subclavian artery.

Both muscarinic and nicotinic acetylcholine (ACh) receptors are known to be present on the surface of lymphocytes. We have shown that variable amounts of ACh are detectable in the blood of various mammals including humans, and a major portion of blood ACh is localized in circulating mononuclear leukocytes in humans. In order to investigate which types of blood cell are the source of ACh in human blood, expression of mRNA for choline acetyltransferase (ChAT, EC 2.3.1.6), which catalyzes ACh synthesis, was analyzed using human leukemic cell lines as models of lymphocytes and the reverse transcription-polymerase chain reaction (RT-PCR) method. We observed that mRNA for the same ChAT as that in the nervous system is expressed constitutively in all the T-cell lines tested, but not in B-, pre-lymphoma or monocytic cell lines. Furthermore, only T-cell lines showed high ACh-synthesizing activities and intracellular ACh contents. These results suggest that the major portion of ACh in the circulating blood originates from T-lymphocytes.

Two cases are presented in which membranocystic lesions were observed in the cartilaginous tissue of surgical specimens. In both cases, the histological and ultrastructural features were reviewed, and S-100 protein distribution was examined immunohistochemically in one case. In both cases, the membranocystic lesions were observed to be adjacent to ballooned chondrocytes. In one case, several chondrocytes showed partially membranocystic lesions in their cytoplasm. The chondrocytes and nuclei in membranocystic lesions were stained positively for S-100 protein. It is suggested that the membranocystic lesions in the cartilaginous tissue were associated with the degeneration of the chondrocytes.

虫垂に限局したCrohn病は非常にまれな疾患で, 本邦では10例の報告をみるにすぎない. 今回, われわれは虫垂Crohn病と診断された1例を経験したので報告する. 症例は20歳の男性, 右下腹部痛を主訴に当科を受診した. 受診時, 右下腹部に圧痛, 筋性防禦を認めた. 腹部超音波, 腹部CTで回盲部に腫大した腫瘤陰影を認めた. 急性虫垂炎と診断し, 緊急開腹術を施行した. 虫垂は炎症性に著明に腫大しており, 35×30mmの大きさであった. 虫垂腫瘍と診断し, 2期的にD2リンパ節郭清を伴う回盲部切除を施行した. 術後の病理組織検査で, 虫垂に全層性炎症性病変, 非乾酪性小型肉芽腫および裂溝が認められ, 虫垂Chohn病と診断された. 術後経過は順調で, 2年経った現在, 再発の徴候は認めていない.

Hernia uteri inguinalis in male hermaphroditism is rare and there have been only 54 other similar cases in Japan. We present a case of hernia uteri inguinalis in male hermaphroditism. A 52-year-old man was admitted to the hospital because of painful swelling involving the scrotal sac and right inguinal region. Abdominal CT scan and magnetic resonance imaging (MRI) revealed a tumor shadow and intestinal gas extending from the scrotal sac to right inguinal region. The preoperative diagnosis was incarceration of hernia inguinalis of the intestinal tract. Radical operation for hernia inguinalis was performed. Hernia sac contained the sigmoid colon and two ovary-like, two salpinx-like and uterus-like structures were found in the right inguinal canal. Histopathologically, the ovary-like structure was the testis and the uterus-like structure was the urerus. The chromosomes and hormonal examinations were normal.

AC-DC converter transformer is one of the most important equipments in the high-voltage D.C. transmission system. And the mineral insulating oil and pressboard immersing in oil are important insulation dielectrics used in AC-DC converter transformers. Thus, it is very significant to understand the dielectric properties of the mineral insulating oil and oil-pressboard. In this paper, the DC breakdown of two new mineral insulating oils and a pressboard immersing in these oils under different temperature has been systematically investigated. The oil and oil-pressboard was degassed and dehydrated before the test. In the testing progress, the test device of breakdown strength was protected by nitrogen and isolated from outside. The breakdown strength of two kinds of mineral insulating oil were tested at five temperatures with the range of 25-80°C, and the breakdown strength of pressboard immersed in both oil were also tested at three temperature with the same range. From the results, it can be obtained that the breakdown strength of oil increased with the increase of temperature, whereas the oil-pressboard showed opposite tendency. This paper enhanced the understanding of the breakdown strength for mineral insulating oil and pressboard immersed in oil, provided the theoretical and test basis to expand the engineering application of this mineral insulating oil and pressboard.

The purpose of this study was to evaluate oxygen uptake 2 (VO )  during aerobic exercise with a Hybrid Training System (HTS) at a moderate intensity. Recently it is said that the combined application of electrical stimulation (ES) and Volitional Contractions (VC) is effective. A Hybrid Training System (HTS) has been developed as a resistance exercise method combining ES with VC, and using electrically stimulated eccentric antagonist muscle contractions as a resistance to voluntary agonist muscle contractions. The benefits of combining aerobic exercise and resistance exercise have also been reported. Therefore, we devised an exercise method that combines the resistance exercise of HTS with aerobic cycling exercise. However, the influence of HTS on aerobic exercise has not been confirmed. Outcome measurements of expired gas were compared during conventional ergometer exercise with and without HTS. 11 healthy young men exercised on a cycle ergometer starting at 20 Watts and increasing by 20 Watts every 3 minutes to 100 Watts, with volitional contractions alone (VER) and with HTS (HER). During each VER and HER test, 2 VO  , carbon dioxide output 2 (VCO )  , expired ventilation (VE) and heart rate (HR) was measured. HR, 22 VO ,VCO  and VE  showed a linear relation with workload during both VER and HER. 2 VO  during HER was significantly higher than during VER at an average of about 21.1% (p

We followed patients who were stone-free after extracorporeal shock wave lithotripsy (ESWL) to investigate the factors that contributed to recurrent calculi.For longer than 5 years 903 patients without residual fragments 3 months after ESWL were enrolled in this study. Plain abdominal films and/or excretory urograms were evaluated every 6 months for recurrent stones on the side of ESWL. Patients who presented with colic pain or other complaints and who were suspected of having recurrent stones were also examined. Stone recurrence rates were calculated with the Kaplan-Meier method. We assessed the influence of patient age; size, location, composition and configuration of the original stones, and pyuria after ESWL on stone recurrence.Mean followup was 25 months and stones recurred in 183 of 903 renal units (20.3%). Kaplan-Meier recurrence rates were 6.7, 28.0 and 41.8% after 1, 3 and 5 years, respectively. There was a significant correlation between stone recurrence and multiple stones on one hand, and pyuria after ESWL on the other hand. Stones recurred most frequently in the lower calix. Recurrent stones were passed without intervention in 33 cases, while ESWL was repeated in 53.These data demonstrate the importance of long-term followup and the search for an effective prophylactic therapy to prevent recurrence.

Sixteen patients (23 feet) who underwent split posterior tibial tendon transfers were evaluated. The patients were seen on a followup basis for a minimum of 1 year postoperatively. The causes were spastic cerebral palsy in 13 feet, spastic-athetoid cerebral palsy in 3 feet, hydrocephalus in 3 feet, and other diseases in 4 feet. The indication for surgery was varus deformity during the stance phase of gait and increased varus deformity during the swing phase of gait because of spasticity of the posterior tibial muscle. Heel cord lengthening was done on 17 feet. Preoperative and postoperative gaits were evaluated while the patients were walking. Axial radiographs of the calcaneus and the tibia were taken of all patients while they were weightbearing. There were 15 excellent, 6 good, and 2 poor results. The poor ratings were assigned to patients who had recurrence of varus deformity; there were no cases of overcorrection. Split posterior tibial tendon transfer was effective for treating spastic varus deformity of the hind part of the foot. This treatment also could be considered for a patient with spastic-athetoid cerebral palsy, if the deformity was determined to be caused by overactivity of the tibialis posterior muscle.

Acetylcholine (ACh) is present in human blood and localized in T-lymphocytes which exhibit ACh-synthesizing activity. As the final step towards clarifying the origin of ACh present in the blood, we elucidated the enzyme involved in ACh synthesis in T-lymphocytes by detecting the mRNA for choline acetyltransferase (ChAT), which is known to catalyze ACh synthesis in the nervous system. The ChAT mRNA in the MOLT-3 human leukemic T-cell line was amplified by reverse transcription-polymerase chain reaction (RT-PCR) using specific order and reverse primers. A single specific RT-PCR product was observed on agarose gel. The sequence of the RT-PCR product of MOLT-3 was completely identical with nucleotide positions 322-973 of human brain ChAT cDNA. Western blot analysis with an antibody to ChAT confirmed the presence of ChAT protein in MOLT-3. These findings demonstrate that mRNA for the same ChAT as that in the nervous system is expressed in T-lymphocytes, and indicate that ACh synthesized by ChAT in T-lymphocytes is the origin of ACh in the blood.

Background The purpose of this study was to reveal any association between cardiorespiratory fitness level and excess post-exercise oxygen consumption (EPOC) using three cycling protocols with varying degrees of exercise intensity, i.e., sprint interval training (SIT), high-intensity interval aerobic training (HIAT), and continuous aerobic training (CAT). Findings Ten healthy men, aged 20 to 31 years, attended a cross-over experiment and completed three exercise sessions: SIT consisting of 7 sets of 30-s cycling at 120% VO2max with a 15-s rest between sets; HIAT consisting of 3 sets of 3-min cycling at 80~90% VO2max with a 2-min active rest at 50% VO2max between sets; and CAT consisting of 40 min of cycling at 60~65% VO2max. During each session, resting VO2, exercise VO2, and a 180-min post-exercise VO2 were measured. The net exercise VO2 during the SIT, HIAT, and CAT averaged 14.7 ± 1.5, 31.8 ± 4.1, and 71.1 ± 10.0 L, and the EPOCs averaged 6.8 ± 4.0, 4.5 ± 3.3, and 2.9 ± 2.8 L, respectively. The EPOC with SIT was greater than with CAT (P < 0.01) and HIAT (P = 0.12). Correlation coefficients obtained between subjects’ VO2max and the ratio of EPOC to net exercise VO2 for SIT, HIAT, and CAT were −0.61 (P = 0.06), -0.79 (P < 0.01), and −0.42 (P = 0.23), respectively. Conclusions Our data suggest that cardiorespiratory fitness level correlates negatively with the magnitude of EPOC, especially when performing aerobic-type interval training.

Background Fucosylated haptoglobin (Fuc-Hpt) is a novel cancer biomarker in a variety of pathological conditions. We previously found that the level of Fuc-Hpt is increased in the sera of patients with pancreatic cancer, and established a lectin antibody ELISA using Aleuria aurantia lectin, which specifically binds to fucosylated residues on oligosaccharides. Methods To apply this assay system to the clinical detection of several diseases, several assay conditions such as serum dilutions and inhibitory factors were investigated. The Fuc-Hpt kit was available for 25–625 fold serum dilution. Results While the values of Fuc-Hpt assay using sera and plasma were different, they showed positive correlation. The addition of bilirubin and formagine did not influence on Fuc-Hpt assay, but hemoglobin inhibited this assay in a dose-dependent manner. Conclusions We reevaluated this lectin antibody ELISA kit for measuring fucosylated haptoglobin in various conditions in this study.

This paper investigates the electromagnetic wave propagation properties in a transformer tank model with coil by experiment and finite difference time domain (FDTD) analysis. Especially, this paper deals with the effects of the windings and PD source on the EM wave propagation and frequency characteristics. As a result, it is found that the coil acts as a loop antenna. It is also indicated that the behavior as the loop antenna causes the frequency giving the best detection sensitivity of PD radiated electromagnetic waves to shift to the lower frequency.

Introduction Astronauts experience weight loss during spaceflight. Future space missions require a more efficient exercise program not only to maintain work efficiency, but also to control increased energy expenditure (EE). When discussing issues concerning EE incurred through exercise, excess post-exercise energy expenditure (EPEE) must also be considered. The aim of this study was to compare the total EE, including EPEE, induced by two types of interval cycling protocols with the total EE of a traditional, continuous cycling protocol. Methods There were 10 healthy men, ages 20 to 31 yr, who completed 3 exercise sessions: sprint interval training (SIT) consisting of 7 sets of 30-s cycling at 120% VO2max with a 15-s rest between each bout; high-intensity interval aerobic training (HIAT) consisting of 3 sets of 3-min cycling at 80-90% VO2max with a 2-min active rest at 50% VO2max; and continuous aerobic training (CAT) consisting of 40 min of cycling at 60-65% VO2max. During each session, resting metabolic rate, exercise EE, and a 180-min post-exercise EE were measured. Results The EPEEs during the SIT, HIAT, and CAT averaged 32 +/- 19, 21 +/- 16, and 13 +/- 13 kcal, and the total EE for an entire exercise/ rest session averaged 109 +/- 20, 182 +/- 17, and 363 +/- 45 kcal, respectively. While the EPEE after the CAT was significantly less than after the SIT, the total EE with the CAT was the greatest of the three. Discussion The SIT and HIAT would be potential protocols to control energy expenditure for long space missions.

The pressboard is an important solid insulation dielectric in AC-DC converter transformers. Thus, it is very significant to understand the dielectric properties of the oil-impregnated pressboard. In this paper, the volume resistivities of oil-impregnated pressboard under different conditions have been systematically investigated. The pressboard was immersed in two kinds of mineral insulation oil, respectively. The measuring device of resistivity was full of oil and isolated from outside. All samples were measured at temperature range of 25–80°C under the field strength range of 1–30kV/mm. The influences of the temperature and the field strength on the resistivity of oil-impregnated pressboard have been investigated. The results of the volume resistivity of oil-impregnated pressboard showed that the resistivity of oil-impregnated pressboard decreased with the increase of temperature, and the activation eneregy increased with the increase of field strength. Meanwhile, with the increase of field strength, the resistivity changed slightly at first and then decreased significantly.

We described the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, if metastasis was not found in frozen section. In the presence of positive nodes, optional treatment, such as TUR or castration, other than radical prostatectomy was performed. We performed laparoscopic lymphadenectomy on twenty seven patients between April 1992 and September 1993. They range from 52 to 78 years in age and consist of 4 patients with stage A2, 17 with stage B, and 6 with stage C. We dissected the obturator lymph nodes on bilateral sides. The average operating time was 162 minutes (range 86 to 320 minutes). The average number of nodes removed from the right side was 7.1 +/- 5.9 and 6.1 +/- 4.5 from the left side, which was comparable to the number of lymph nodes obtained by open dissection. Colon injury occurred in one patient, which was managed by laparotomy procedure. Nodal metastases were found in 6 patients by frozen section, and in 10 patients by permanent section. This discrepancy suggested that two-staged operation might be preferable for the localized prostate cancer. Six patients were given suitable therapies besides radical prostatectomy. Laparoscopic pelvic lymphadenectomy is a safe and useful procedure for prostate cancer, especially for the patients who are likely to have nodal metastasis.

To evaluate endoscopic trigonoplasty compared to open trigonoplasty for vesicoureteral reflux, we analyzed clinical results, complications, the use of analgesics for postoperative pain and bladder irritability and postoperative length of hospitalization. One of six patients undergoing endoscopic trigonoplasty subsequently underwent open trigonoplasty due to failure of trocar placement, therefore, 7 patients having vesicoureteral refluxy renoureteral units underwent open trigonoplasty and 5 patients with vesicoureteral reflux 7 renoureteral units underwent endoscopic trigonoplasty. Mean operative time was 143 +/- 48 minutes for open surgery and 185 +/- 54 minutes for endoscopic surgery. Vesicoureteral reflux disappeared in 8 renoureteral units but was worse in one unit after open trigonoplasty, while vesicoureteral reflux subsided in 6 units and improved in one unit from grade II to grade I after endoscopic trigonoplasty. There were no intraoperative complications after open surgery, while one patient had pneumoperitoneum due to inadequate placement of a trocar during endoscopic surgery. There were no early postoperative complications after endoscopic surgery. However, 2 patients developed hematuria after open surgery. The degree of postoperative pain and irritability following endoscopic trigonoplasty was lower than that after open trigonoplasty and analgesics were used less frequently after endoscopic surgery. The mean postoperative hospital stay was 16.7 +/- 3.2 days for open surgery and 14.4 +/- 2.9 days for endoscopic surgery. These results indicate that endoscopic trigonoplasty is a useful procedure for vesicoureteral reflux because it is minimally invasive.

This case report describes a rare case of recurrent dislocation of the patella which was accompanied with trochlear dysplasia and malalignment of the patella in a 15-year-old girl. She complained of hemoarthrosis and recurrent patellar dislocation in the early knee flexion phase. Plain radiography and computed tomography (CT) showed patellar malalignment (quadriceps angle 20°) and severe dysplasia of the trochlea of the femur (sulcus angle 170°). Surgery was performed, consisting of trochleoplasty in addition to proximal and distal realignment. Trochleoplasty was undertaken using a modified Dejour technique. After surgery, the patient complained of joint contracture. Arthroscopic release of fibrous tissue relieved symptoms and obtained normal range of motion without patellar dislocation. Postoperative radiography and CT demonstrated improvement of the quadriceps angle (10°) and sulcus angle (140°).

Safety operation of total ultra-HVDC transmission system could be directly affected by the operation reliability of converter transformer which is one of the most important equipments in the system. The transformer oil is the main liquid dielectric medium in the converter transformer. Thus, it is significant to study the dielectric properties of the transformer oil. In this paper, the dc resistivity of transformer oil under different conditions has been systematically investigated, and then the temperature and field strength were the test parameter variables. The variation range of temperature was 25∼80°C, and under each temperature point the field strength changed ranging from 0.5V/mm to 10kV/mm. Meanwhile, 15 min is selected as the duration of testing resistivity. In this paper, the authors obtained the systematical data points and analysis curves of resistivity under different temperature and field strength, and obtained a empirical equation which describe the relationship between resistivity, temperature and field strength. It enhanced the understanding of the resistivity for transformer oil and provided the theoretical and test basis to expand the engineering application of this transformer oil.

In order to minimize the late complications of transurethral ureterolithotripsy with a rigid ureteroscope such as distal ureteral stricture or vesicoureteral reflux, we have performed a balloon dilation of the ureteral orifice and the intramural ureter prior to insertion of a rigid ureteroscope in 62 cases with ureteral calculi between October 1986 and December 1991. A 7F balloon dilator (Bard Co. USA) was cystoscopically inserted into the ureter over a 0.038 inches Radifocus guide wire (Terumo Co., Japan) and then, a balloon was inflated to 15F size with saline using a 10 ml disposal syringe. Thereafter, an 11.5F rigid ureteroscope (Wolf Co., Germany) was inserted instead of a balloon dilator. The stone was disintegrated and removed by ultrasonic lithotripter, electrohydraulic lithotripter and/or basket forceps. The stone was removed completely in 45 cases (72.6%) and incompletely in 10 (16.1%). In 7 cases (11.3%), the stone removal was failed. Long-term follow up with an excretory urography obtained at 6 months or later in 31 cases showed no distal ureteral stricture. Voiding cystography was performed in 33 cases at a mean 2.8 months postoperatively and no vesicoureteral reflux was observed. In control group, 309 cases were treated with transurethral ureterolithotripsy without dilation of the ureteral orifice and the intramural ureter between the same period. A complete removal was achieved in 262 cases (84.8%) and an incomplete removal in 16 (5.2%). 31 (10%) was failed. Distal ureteral stricture due to this procedure was found in 3 cases (2.1%) in 141 long term followed up cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Since July 1991, we have performed laparoscopic nephrectomy for removal of damaged kidneys in thirteen patients. In addition, we recently developed a new procedure of laparoscopic nephrectomy for renal cell carcinoma and successfully removed the kidney with renal cell carcinoma. Patients' age ranged from 18 to 80 years with the average being 50 years. There were 8 male and 6 female patients. Original disease was calculous disease in 5 patients, vesicoureteral reflux in 4, renovascular disease in 2, ureteropelvic junction obstruction in 1, ectopic ureter in 1 and renal cell carcinoma in 1. The mean size of the diseased kidney was 9 x 5 x 4 cm in the initial 13 cases and 13 x 7 x 6 cm in the case with renal cell carcinoma. The size of the tumor was 2.5 x 2 x 2 cm. In the first 13 patients, nephrectomy was performed as described previously. In the patient with renal cell carcinoma, a new procedure was applied. In the new procedure, five trocars were introduced into the abdominal cavity through the lateral abdominal wall. The kidney was removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia in the same fashion as traditional radical nephrectomy. Thirteen kidneys were successfully removed, but one failed because of dense adhesion to the surrounding tissue. Three of the 13 patients required additional laparotomies to control bleeding or to remove missed stone.(ABSTRACT TRUNCATED AT 250 WORDS)

Transrectal hyperthermia was performed on 13 patients with chronic non-bacterial prostatitis which failed to respond to the conventional treatments. We used "Prostathermer" (Biodan-Medical system, Israel) for heating the prostate gland. The prostate was heated at 42 degrees C-43 degrees C, for 60 minutes in 1 session. Treatment consisted of 6 sessions, and was performed during a period of three weeks on an outpatient basis. Of 11 patients re-evaluated after 3 months, 6 (55%) achieved improvement of subjective symptoms. Of 9 patients, 4 (44%) showed reduction of the number of white blood cells (> or = 10 leukocytes count per high-power field) in their expressed prostatic secretion (EPS), which however was not always correlate with improvement of subjective symptoms. No complications were encountered in our series. Our result indicates that local hyperthermia is safe, and would become new modality in the treatment for chronic prostatitis.

熱希釈法による右室駆出率(right ventricular ejection fraction: RVEF)測定を中心として褐色細胞腫摘出術中の血行動態を測定し,RVEFの意義を検討した.血中カテコラミン濃度の変動に伴い,血圧,心係数,右室拡張終期容量等は著明に変動したが,RVEFはほとんど変動しなかった.RVEFは右室容量負荷および圧負荷による影響を受けるため,右室収縮性の指標としては不十分であることが示唆された.

Endopyeloureterotomy has been accepted as a procedure to relieve obstruction of the ureteropelvic junction and upper ureteral stenosis. However, in patients with a long stenotic segment poor results are often obtained with the conventional technique. To resolve this problem we developed a new technique using a 22F urethrotome and a transpelvic extraureteral approach. In this technique the renal pelvis was incised for 1 to 1.5 cm. from the ureteropelvic junction in the direction of the parenchyma using the cold knife of the urethrotome under direct vision. For upper ureteral stenosis the dilated pelvic and ureteral posterolateral walls were incised 1 to 1.5 cm. from the stenotic segment toward the ureteropelvic junction. Then, the stenotic segment was treated with the urethrotome after it was advanced into the retroperitoneal space through the incision in the renal pelvis. We treated 21 patients with the new technique between August 1988 and August 1990. Our series included 3 patients with the high insertion type of ureteropelvic junction obstruction and 4 with a long stenotic segment. The success rate was 95% without any severe complication. These results indicate that our new technique could become a useful procedure for endopyeloureterotomy.

Objectives: We retrospectively reviewed the clinical outcome and long-term cancer control of patients with localized large renal-cell carcinomas (RCCs) who underwent laparoscopic radical nephrectomy in comparison to open procedure. Patients and Methods: One hundred and thirty-one patients with RCCs greater than 7 cm who underwent radical nephrectomy between 1996 and 2008 were studied: 52 patients in the laparoscopy group and 79 in the open group. In this analysis patients who had metastasis or pT4 disease or tumor thrombus in the inferior vena cava were excluded. The median follow-up period was 41 months in the laparoscopy group and 51 months in the open group. Results: Patients in the laparoscopy group had tumors similar in size to those in the open group (88 and 89 mm, respectively), lesser blood loss (245 and 663 mL p < 0.01), but more intraoperative complications (15% and 2.5%). One laparoscopy patient was converted to open surgery because of an injury to the inferior vena cava (IVC). The 5- and 10-year disease-free rates and patient-survival rates were comparable in both groups. Conclusions: Laparoscopic nephrectomy is feasible for localized large RCC, although intraoperative complications were more frequent. No statistically significant differences were found in either disease-free or cause-specific patient survival rates between the laparoscopy and the open groups. Laparoscopic nephrectomy can be an alternative to the open procedure for localized large RCC. However, a longer follow-up period is necessary to confirm the oncological efficacy of this procedure.

As we know, streaming electrification due to oil flow is an important phenomenon in power transformers particularly on those high rated voltage ones, and the study around it is still a challenge. In this paper, the streaming electrification characteristic of insulation mineral oil from Nynas was studied by using an improved mini-static tester to measure the electrostatic charging tendency (ECT) of oils with different aging conditions. The oil samples were aged under 120°C in different periods up to 1350 hours, and together with different contents of oxygen and a certain amount of copper and pressboard. A comparatively better linear correlation is shown between ECT and volume resistivity (ρ v ), dissipation factor (tanδ) and water content, The tanδ and water content are increasing gradually with the aging time prolonged, while ρ v and carboxyl decrease slowly, the acid number does not present evident fluctuation during the whole aging periods.

As a prospective study on asymptomatic microhematuria, complete urological examinations including cystoscopy, IVP, ultrasound and urinary cytology were performed on 422 patients over 40 years old between January 1987 and December 1988 (group A). The results of group A was compared with that of retrospective study on 266 patients, who had incomplete urological examination between January 1984 and December 1985 (group B). Cystoscopy was performed on 321 patients (87.2%) in group A and on 108 patients (40.6%) in group B. Bladder tumor was found in 10 cases (2.4%) in group A, including 7 cases of male patients (5.7%), but in only 1 case (0.4%) in group B. Since the negative rate of abnormal urinary cytology was 50% and that of abnormal IVP was 90% in 10 cases of bladder tumor in group A, cystoscopy was considered to be an essential examination for the screening of patients with asymptomatic microhematuria over 40 years old patients.

Purpose:: The Bandloop is a new electroresection loop that is broader than the standard loop and thickens from front to back. We compared the safety and efficacy of the Bandloop to the conventional loop electrode for transurethral prostatectomy.Materials and Methods:: A randomized prospective study was performed on 53 patients with lower urinary tract symptoms and estimated prostatic volume greater than 30 ml. on transrectal ultrasonography. The Bandloop was used in 25 cases (Bandloop group) and standard loop was used in 28 (standard group). Surgical outcomes, including International Prostate Symptom Score, resected prostatic weight, operative time, uroflowmetry, post-void residual urine, postoperative catheterization period, time to disappearance of macrohematuria, and serial changes of hemoglobin and urinalysis, between the 2 groups were compared.Results:: A total of 23 Bandloop and 28 standard loop cases were evaluable. There was no difference in preoperative estimated prostatic volume (mean 44.7 versu...

To develop a screening test to identify community dwelling elderly people who are in need of assistive care but whose activities of daily living (ADLs) can be improved by appropriate rehabilitation intervention, so-called 'quasi-in-need-of-care state (QUINOCS)'.A total of 32 persons (mean age 77.3 years) from the metropolitan area and 51 persons (mean age 82.7 years) from a rural area were enrolled. Two physiatrists examined them and judged whether they could benefit from rehabilitation intervention while visiting nurses evaluated their ADLs using the Functional Independence Measure (FIM). A screening test to identify the QUINOCS was created using a seven-item subset score of the FIM (feeding, bathing, dressing lower-body, bladder management, bed/chair/wheel chair transfer, walking/wheel chair, stairs).Fourteen in the metropolitan and 19 in the rural inhabitants were judged as the QUINOCS by the physiatrists. Persons whose subset scores included or ran across the intermediate range of independent levels (scores 3 and 4 of the FIM) showed tendency to be judged suitable for rehabilitation intervention. This finding was applied for screening algorism to identify the QUINOCS. Sensitivity and specificity of this test were 0.71 and 0.78 for the metropolitan, and 0.74 and 0.78 for the rural groups, respectively.The screening method using the 7-item subset of the FIM can be used for identification of the QUINOCS among elderly people efficiently.

The present study was prospectively conducted for female patients with wet overactive bladder to assess the efficacy of propiverine hydrochloride in improving their symptoms and quality of life (QOL). Propiverine hydrochloride was administered orally to 58 patients for 8 weeks. Prior to administration and at 4 and 8 weeks after administration, symptoms and QOL were assessed by the micturition diary, the International Consultation on Incontinence-Short Form (ICIQ-SF), and the King's Health Questionnaire (KHQ). After administration, numbers of daily micturitions, incontinence episodes, urgency episodes and severity of urgency which were assessed based on the micturition diary and urgency scale questionnaire showed significant improvement when compared to baseline values. Furthermore, both ICIQ-SF and KHQ scores improved significantly after administration. The incidence of adverse events was 23.8% and none were serious. Propiverine hydrochloride was shown to contribute not only to the improvement of symptoms in female patients with wet overactive bladder but also to their QOL.

The long term results of 28 HLA 1-haploidentical donor kidney transplant recipients receiving preoperative lymphocyte deletion through thoracic duct drainage and low dose of steroid and azathioprine immunosuppressive treatment were presented. The number of removed lymphocytes was 129.9 +/- 38.1 x 10(9) (mean +/- SD) and the duration of thoracic duct drainage pretreatment was 35 +/- 4 days. Graft survival was 96% at 3 months through 2 years, 89% at 3 years and 84% at 5 years. Patient survival was 100% at 3 months through 2 years and 96% at 3 years through 5 years. Fifteen acute rejection crises were observed in 13 patients within the first 3 months postoperatively. There was no irreversible rejection in the first 3 months. Four chronic rejections were observed in 4 patients. Life-threatening infectious disease was observed in 5 patients, diabetes mellitus in 2 and cataract in 4. These results indicated that the reduction of the dose of steroid in post transplant period might have beneficial effects on the long term graft survival of HLA 1-haploidentical kidney transplant patients receiving TDD pretreatment and the conventional immunosuppressive treatment.

One hundred and forty-four patients primarily receiving kidneys from cadaver donors between Jan., 1978 and Oct., 1989, were reviewed. The patients' ages ranged 14-53 with a mean +/- S.D. of 34.7 +/- 8.0 years old. There were 100 males and 44 females. Twenty kidneys were harvested from heart-beating donors and 124 from non-heart-beating donors. In harvest from non-heart-beating donors, we performed in situ cooling through a double balloon catheter placed in the aorta to minimize prolonged warm ischemia. The number of matched HLA A, B antigens was (mean +/- S.D.) 1.7 +/- 0.8 antigens and for HLA DR antigens, it was 1.2 +/- 0.5. One hundred and nineteen of the 144 recipients have had a history of blood transfusion preoperatively. The patients were treated with four different immunosuppressive protocols; regimen I consisting of horse antilymphocyte globulin (ALG), regimen II of large-dose (14 mg/kg/day) of cyclosporin (CsA) and steroid, regimen IIIa of low-dose (4 mg/kg/day) of CsA, steroid and a short course of ALG (500 mg/day) and regimen IIIb of low-dose (6 mg/kg/day) of CsA, steroid and a short course of ALG (1000 mg/day). Fifteen patients received regimen I therapy from Jan., 1978 to Nov., 1982, 49 received regimen II from Nov., 1982 to Dec., 1986, 23 received regimen IIIa from Jan., 1987 to Dec., 1987 and 57 received regimen IIIb from Jan., 1988 to Oct., 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty-two patients with obstructive diseases of the upper urinary tract were treated by percutaneous endoscopic surgery between May, 1986 and July, 1989. Fifty-nine procedures consisting of endopyelotomy (24 procedures), endopyeloureterotomy (29) and balloon dilation under direct vision (6) were performed in 54 units of the urinary drainage system. Causative diseases were congenital in 24 units, scar due to calculi in 17, scar due to previous surgery in 11 and tuberculous ureteritis in 2. The postoperative follow-up periods ranged from 3-41 months, mean +/- S.D.; 12.2 +/- 7.3 months. Of the 59 procedures, 49 (83.1%) achieved improvement but 10 could not on the postoperative excretory pyelogram and/or TcDTPA renogram. Three procedures (5.5%) required blood transfusion. Retroperitoneal leakage of the perfusate was observed in 3 procedures (5.0%). No other severe complications were observed. These results indicate that this procedure may be used for the reconstructive surgery in obstructive diseases of the upper urinary tract such as the ureteropelvic junction and the proximal 1/3 ureter.

The results of 20 HLA 1-haploidentical donor kidney transplant patients treated with preoperative lymphocyte deletion through thoracic duct drainage and low dose of cyclosporine and steroid immunosuppressive therapy, were presented. The number of removed lymphocytes was 114 +/- 36 X 10(9) (mean +/- SD) and the duration of thoracic duct drainage was 35 +/- 7 days. Graft survival was 100% at 3-9 months and 89% at 1-2 years after transplantation. Patient survival was 100% at 3-9 months and 89% at 1-2 years. A patient died from lung cancer (adenocarcinoma) in the 9th posttransplant month. Acute rejection was not seen in 20 patients during the first 3 months. Life-threatening infectious disease was never seen either. Diabetes mellitus was observed in 1 patient. No other complications were observed. These results indicated that thoracic duct drainage and low dose cyclosporine and steroid postoperative immunosuppressive treatment might yield complete success in HLA 1-haploidentical kidney transplant patients.

Increase in static electrification and discharge generation was experienced during the service operation of aged power transformers of both shell and core-form. However, the electrical characteristics of the oil did not demonstrate increase in static electrification. The investigation on the aged oil by measurement of electrostatic charging tendency suggested the possibility that some deteriorated compound in oil was adsorbed to the pressboard and increased the static electrification. However, the measurement of electrostatic charging tendency with the aged pressboard did not demonstrate enough increase, whereas accumulated charge measurement of the aged pressboard confirmed strong increase in static electrification. On the other hand, the measurement of accumulated charge by potential measurement confirmed strong increase of charge accumulation by the pressboard aging. It was suggested that measurement of accumulated charge was suitable for the assessment of static electrification in aged transformers.

北海道十勝支庁芽室町産のエンドウヒゲナガアブラムシ(十勝系統)の無翅成虫を15±1°C, 16L:8Dの室内条件下でしょ糖濃度とpHが異なる人工飼料上で育て,生存率,寿命,産子数を調査した.1) 生存率,寿命,産子数の値はいずれもしょ糖濃度45g/100ml, pH 8.3のとき最大値となった.飼料に移してから10日目の無翅成虫の生存率は75.0%,平均寿命は17.8±2.0日となり,ソラマメ芽出し上での生存率85.7%,寿命20.5±1.7日と有意差がなかった.平均産子数は32.0±2.4個体でソラマメ芽出し上での値の45.3%であった.2) 十勝系統ではAkey and Beck (1972)の示した値と異なるしょ糖濃度,pH値が生存率,寿命,産子数に関する最適値となり,アブラムシの系統間でこれらの最適値が異なることがわかった.