Gasless endoscopic thyroid and parathyroid surgery using a new retractor.

Endoscopic thyroid and parathyroid surgery have now become feasible procedures, but the working space provided by the gasless technique is more limited than that of the CO2 insufflation technique. Gasless endoscopic surgery was performed in 20 patients with thyroid or parathyroid tumors. A newly designed retractor was used.

Biomechanical evaluation of anterior spinal instrumentation systems for scoliosis: in vitro fatigue simulation.

Study Design: A biomechanical study was designed to assess the bone-screw interface fixation strength among five anterior spinal instrumentation systems for scoliosis before and after a fatigue simulation.

Objectives: The objectives of the current study were twofold: 1) evaluate the static (initial) strength at the bone-screw interface and 2) evaluate dynamic (post fatigue) strength of the bone-screw interface after a fatigue simulation to investigate a possible mechanism for postoperative loss of correction.

Summary Of Background Data: Although the recent advancement of anterior instrumentation for scoliosis has permitted shorter fusion segments and improved surgical correction, the loss of correction over the instrumented segments still has been reported in one-rod systems.

Induction of MMP-9 in normal human bronchial epithelial cells by TNF-alpha via NF-kappa B-mediated pathway.

In this study, we determined whether the proinflammatory cytokines tumor necrosis factor (TNF)-alpha and interleukin-1 beta contribute to the regulation of matrix metalloproteinase (MMP)-9 in human bronchial epithelial cells and whether the induction of MMP-9 is regulated by the transcription factor nuclear factor (NF)-kappa B. We demonstrated that TNF-alpha induced MMP-9 at both the protein and mRNA levels in human bronchial epithelial cells and that interleukin-1 beta did not. In contrast, induction of the tissue inhibitor of metalloproteinase-1 by TNF-alpha was less than that of interleukin-1 beta.

Cerebral ischemic complications following intracranial bleeding in patients with moyamoya disease--three case reports.

Three patients with bleeding-type moyamoya disease suffered ischemic complications following their first episode of intracranial bleeding. The patients presented with intraventricular hemorrhage and suffered cerebral infarction on the 14th, 16th, and 11th days after the ictus, respectively. The clinical records revealed no obvious hypotension before progression to infarction and suggested that dehydration accelerated by the administration of hyperosmotic drugs was a contributing factor to the infarction.

Dosimetric predictors of radiation esophagitis in patients treated for non-small-cell lung cancer with carboplatin/paclitaxel/radiotherapy.

Purpose: To establish dosimetric predictors of radiation esophagitis (RE) in patients treated with a combination of carboplatin, paclitaxel, and radiotherapy.

Methods And Materials: Three-dimensional radiotherapy plans of 26 patients with non-small-cell lung cancer who received 50-60 Gy of radiotherapy concurrently with weekly administration of carboplatin (AUC 2) and paclitaxel (40-45 mg/m(2)) were reviewed in conjunction with RE. The factors analyzed included the following: percentages of organ volumes receiving >40 Gy (V40), >45 Gy (V45), >50 Gy (V50), and >55 Gy (V55); the length of esophagus (total circumference) treated with >40 Gy (LETT40), >45 Gy (LETT45), >50 Gy (LETT50), and >55 Gy (LETT55); the maximum dose in the esophagus (Dmax); and the mean dose in the esophagus (Dmean).

Biomechanical and morphologic evaluation of a three-dimensional fabric sheep artificial intervertebral disc: in vitro and in vivo analysis.

Study Design: We have developed a new artificial intervertebral disc consisting of triaxial three-dimensional fabric for the sheep lumbar spine. To clarify the characteristics of the new implant, a series of biomechanical tests and morphologic evaluations were conducted.

Objectives: To investigate the static, viscoelastic, and fatigue properties of the three-dimensional fabric disc in comparison with natural sheep disc and to evaluate their biomechanical and morphologic alteration in vivo.

Familial adult onset primary alveolar hypoventilation syndrome.

A 41-year-old man fell into type II respiratory failure after catching a cold, and became dependent on a respirator. Chest radiography showed no abnormalities and the hyperventilation test showed improved arterial blood gas findings. His sleep study showed marked nocturnal desaturation due to hypopnea and apnea with a decrease of thoracic and abdominal movement during sleep.

Bronchial hyperresponsiveness and exhaled nitric oxide in patients with cardiac disease.

Background: Increased concentrations of exhaled nitric oxide (NO) correlate with increased airway inflammation and measurement of exhaled NO is a noninvasive method for the management of bronchial asthma. In various cardiac diseases, bronchial hyperresponsiveness is observed, as is bronchial asthma. However, there have been few studies on the relationship between exhaled NO and bronchial responsiveness in cardiac diseases.

[Refractory non-small-cell lung cancer responding to combination chemotherapy with docetaxel, gemcitabine and cisplatin].

The combination of docetaxel (TXT), gemcitabine (GEM), and cisplatin (CDDP) produced a regression in a squamous cell carcinoma of the lung that had recurred after radiation therapy plus chemotherapy, and was resistant to the combination of carboplatin (CBDCA) with etoposide (ETP) or paclitaxel (TXL). The patient was a 62-year-old man with squamous cell lung cancer, which was first successfully treated by a combination of radiation therapy and chemotherapy, but showed local recurrence after 8 months. Although the recurrence was treated with CBDCA plus ETP and then TXL, the tumor continued to grow with symptomatic progression of airway stenosis.

[Pulmonary adenocarcinoma with central ossification].

A 70-year-old woman was admitted in April 1997 because a coin lesion in the left middle lung field was observed on chest roentgenograms. The lesion had slightly increased in size since 1994, when it was first pointed out. Chest computed tomography elucidated a high density area with irregular borders in the center of the shadow in S 3 a.

Complications of pedicle screw fixation in reconstructive surgery of the cervical spine.

Study Design: Retrospective evaluation of complications in 180 consecutive patients with cervical disorders who had been treated by using pedicle screw fixation systems.

Objectives: To determine the risks associated with pedicle screw fixation in the cervical spine and to emphasize the importance of preoperative planning and surgical techniques in reducing the risks of this procedure.

Summary Of Background Data: Generally, pedicle screw fixation in the cervical spine has been considered too risky for the neurovascular structures.

Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system.

Object: In this study the authors retrospectively review 16 patients with traumatic disc herniation secondary to middle and lower cervical spine injuries who underwent a single posterior reduction and fusion procedure in which a cervical pedicle screw system was used. The study was undertaken to evaluate whether the procedure effectively reduced the disc herniation and whether it can be safely conducted without performing anterior decompressive surgery.

Methods: A total of 73 patients with middle and lower cervical spine injuries were identified.

Beta2-adrenergic receptor polymorphisms affect airway responsiveness to salbutamol in asthmatics.

We examined the beta2-adrenergic receptor (beta2AR) polymorphisms (Arg16-->Gly, Gln27-->Glu) and clinical status for 117 asthmatics. Airway responsiveness to methacholine and beta2-agonists was evaluated with Astograph. The atopic factors, pulmonary function test, and airway responsiveness to methacholine did not differ significantly among the different beta2AR genotypes.

Static and fatigue biomechanical properties of anterior thoracolumbar instrumentation systems. A synthetic testing model.

Study Design: A mechanical testing standard for anterior thoracolumbar instrumentation systems was introduced, using a synthetic model. Twelve recent instrumentation systems were tested in static and fatigue modes.

Objectives: To establish the testing standard for anterior thoracolumbar instrumentation systems using a synthetic model and to evaluate the static and fatigue biomechanical properties of 12 anterior thoracolumbar instrumentation systems.

Platelet-activating factor increases the expression of metalloproteinase-9 in human bronchial epithelial cells.

Platelet-activating factor (PAF) plays an important role in the pathogenesis of bronchial asthma. To investigate the role of PAF in the maintenance and remodeling of the extracellular matrix, we evaluated the expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 from human bronchial epithelial cells after PAF treatment. Gelatin zymography of human bronchial epithelial cell-conditioned media showed major pro-matrix metalloproteinase-9 and minor pro-matrix metalloproteinase-2 expression and these expressions were totally inhibited by the metalloproteinase inhibitor EDTA.

The effect of stimulus discriminability on stimulus-preceding negativities prior to instructive and feedback stimuli.

Stimulus-preceding negativity (SPN) was recorded in time estimation tasks that allowed the pre-instruction SPN and the pre-feedback SPN to be compared. In the task in which an acoustic tone was presented 3 s after a voluntary movement, (a) the level of stimulus discriminability (easy and difficult), and (b) the information content of the acoustic tone (feedback and instruction) were manipulated. The pre-instruction SPN over the right hemisphere tended to be larger under the difficult than under the easy level of discriminability, but the difference was only marginally significant.

Clinical significance of plasma vascular endothelial growth factor in gastrointestinal cancer.

Circulating vascular endothelial growth factor (VEGF) was measured in gastric and colorectal cancer patients using an enzyme-linked immunosorbent assay (ELISA). Firstly, serum and plasma samples were collected from 20 normal controls to compare the values of VEGF and to determine which specimen type was most suitable for detecting circulating VEGF. Seventeen of 20 normal controls had plasma VEGF levels under the limit of detection (15 pg/ml) and the levels of the remaining three controls were 21, 22 and 38 pg/ml.

The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine. A biomechanical study.

Study Design: The biomechanical role of the cervical uncovertebral joint was investigated using human cadaveric spines. Sequential resection of cervical uncovertebral joints, including clinical anteromedial foraminotomy, was conducted, followed by biomechanical testing after each stage of resection.

Objectives: To clarify the biomechanical role of uncovertebral joints and clinical anteromedial foraminotomy in the cervical spine and their effects on interbody bone graft stability.

Video-assisted thoracoscopic surgery versus open thoracotomy for anterior thoracic spinal fusion. A comparative radiographic, biomechanical, and histologic analysis in a sheep model.

Study Design: In this in vivo investigation, a sheep model was used to compare the efficacy of a video-assisted thoracoscopic approach and a traditional thoracotomy in promoting a successful interbody spinal arthrodesis.

Objectives: To compare the incidence of successful anterior spinal arthrodesis among three stabilization techniques-iliac crest, Bagby and Kuslich device, and Z-plate--performed using a video-assisted thoracoscopic approach and conventional open thoracotomy approaches.

Summary Of Background Data: A clinical outcome study on open versus endoscopic spinal fusion is not yet available.

The effects of spinal fixation and destabilization on the biomechanical and histologic properties of spinal ligaments. An in vivo study.

Study Design: An animal study was conducted to assess whether different surgical procedures of spinal fixation and destabilization would influence the biomechanics and histology of lumbar spinal ligaments.

Objectives: To investigate the effects of spinal fixation and destabilization as well as surgical intervention itself on the biomechanical and histologic properties of lumbar spinal ligaments.

Summary Of Background Data: Although several investigators have reported normal biomechanical properties of different spinal ligaments, there have been no studies in which changes in spinal ligament properties, secondary to the altered biomechanical environment provided by such surgical procedures as spinal fixation and destabilization, have been investigated.

The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis.

Study Design: In vitro biomechanical testing was performed in human cadaveric lumbar spines, using pressure needle transducers to analyze the effects of spinal destabilization and instrumentation on lumbar intradiscal pressures.

Objectives: To quantify changes in lumbar intradiscal pressures at three adjacent disc levels under conditions of spinal reconstruction, and to evaluate the possibility of pressure-induced disc pathology secondary to spinal instrumentation.

Summary Of Background Data: Lumbar intradiscal pressures under in vivo and in vitro conditions and the use and development of spinal instrumentation have been investigated comprehensively.