In the future, we will have more aged patients, more cases of bilateral total hip arthroplasty (THA) and more cases of bilateral revision THA. There are not, however, many reports of long-term follow-up of bilateral revision THA. We report a case of bilateral revision THA followed up for 11 years. A 74-year-old woman presented with bilateral painful hip in 1996. She had undergone left THA in 1984 and right THA in 1986 at another hospital. Her JOA(Japan Orthopaedic Association) scores on her first visit (right/left) were 32 points/31 points. Plain radiographs revealed a clear zone in her bilateral proximal femur. We diagnosed her as having looseness of bilateral THA. She required bilateral revision THA and underwent left revision THA (Charnley) in January 1997 (14 years after the original operation) and right revision THA (Charnley) in July 1997 (12 years after the original operation). After bilateral revision THA, we were able to follow up this patient for 11 years. She had no complaints about her bilateral hip joints, and X-ray examination showed no looseness. The JOA scores and range of motion illustrate the good result achieved for this case.
Right and left ; Tacrine ; Hip ; Arthroplasty ; Serotype eleven

A 26-year-old woman at 40 weeks of gestation attended our emergency department due to sudden onset of chest and back pain, although she had experienced no previous abnormalities. The patient was very tall, had spider fingers and scoliosis, all of which indicated Marfan's syndrome. Enhanced computed tomography and cardiac ultrasonography revealed acute aortic dissection and annulo-aortic ectasia with aortic regurgitation. Thereafter, a baby weighing 3,070g was delivered by emergency Caesarean section and then a Bentall-type operation was performed consecutively. An intraoperative injection of heparin resulted in minimal uterine bleeding. Surgery at the 40th week of gestation was successful for both the mother and the neonate.

An internal felt-reinforced patch-plasty was performed in 11 patients with dissecting aortic aneurysm (DeBakey type I: 4 cases, type II: 1 case, type III: 5 cases, aortic arch dissection: 1 case). The aortic cross-clamp time was 84±19 min on the average. The initial tear of the aortic intima was closed on 10 patients. Minor leakage through a felt inserted in the false lumen was observed in one patient of type I. There was no operation-related death except one patient of type III who died from arrythmia encountered following termination of centrifugal pump bypass. Thrombotic occlusion of the false lumen developed in the ascending aorta in type I and II cases, and in the desceding aorta in type III one month after operation. The false lumen localized in the aortic arch was completely occluded by thromi. Postoperative course was excellent in all patients after 16 months on the average. Internal felt-reinforced patch-plasty is a simple and reliable procedure for closing the intial tear of dissecting aortic aneurysms.

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

A descending thoracoaortic aneurysm excluded by stent-grafting had expanded during a period of one and a half years. There was no endoleakage but there was shortening of the stent-landing on both proximal and distal sides. Aneurysm seemed to be pressed by blood pressure through the graft in TEE. The aneurysm was replaced by an artificial graft through a left heart bypass. Because ESP diminished during the operation, VIth intercostal arteries were reconstructed immediately, and CSF drainage was performed. Following this procedure there was no paraplegia.

We encountered two patients complaining of hiccups following the resection of subaural tumor or subarachnoid hemorrhage. In one patient, we measured the autunomic nerves of Ryodoraku, and placed grains of silver on Ryodoraku points which showed abnormal values. We also used the in situ needle technique on acupoints which were considered to be closely related to the phrenic nerve. Furthermore, we inserted round-head subcutaneous needles in auricular acupoints such as “Kaku”, “Shinmon”, “Hishitsuka”, and “Jichu”. After repeating the above treatment twice, the hiccups disappeared completely. In the other patient who had difficulty even taking off clothes, a subcutaneous needle was inserted into “Kaku”, which was repeated twice a week. After five months, the hiccups disappeared completely.
Based on our experience with the two patients above, we had the impression that auricular acupuncture is particularly effective. “Kaku” was the main acupoint used, which is believed to influence the diaphragm. We believe that this technique can therefore be used clinically in the future.

The therapeutic effect of a cordless mini TENS on shoulder stiffness and painful diseases and patients' favorite intensity of stimulation were studied. Effect of this apparatus on peripheral circulation was also examind using a laser Doppler measuring instrument. The 114 cases with shoulder stiffness used the TENS only once (SS group), and the 53 cases continuasly (SC group). The 65 cases with painful diseases used the TENS only once (PS group) and the 53 cases continuasly (PC group). A great majority of the patients prefered stimulation with moderate frequency and high intensity. Effectiveness was seen in 76% of SS group and 87% of SC group, and in 75% of PS group and 91% of PC group. Peripheral circulation was significantly increased after the stimulation of the apparatus.

OBJECTIVETo examine suppressive effects of multi-glycoside of Tripterygium wilfordii Hook. f. (GTW)on mesangial injury induced by two-injecti on of anti-Thy1. 1 monoclonal antibody(mAb) 1-22-3 in vitro.

METHODWe established the irreversible model of glomerulosclerosis with anti-Thy1. 1 mAb 1-22-3. After 42 days of oral treatment with GTW (50 mg x kg(-1) BW)and vehicle (distilled water), to observe effects of GTW on proteinuria, renal function, mesangial morphological change, and mRNA expressions of collagen type I and TGF-beta by light microscope (LM), immunofluorescence (IF), and Reverse Transcription Polymerase Chain Reaction (RT-PCR).

RESULTGTW ameliorated proteinuria (from day24 to day 42) and mesangial proliferation [total cell number, GTW group 65.67+/-3.43 vs. control group 87.02+/-2.41, P < 0.05; matrix expansion, GTW group 1.20+/-0.06 vs. control group 2.77+/-0.23, P < 0.05; alpha-smooth muscle actin(alpha-SMA) expression, GTW group 1.75+/-0.33 vs. control group 2.62+/-0.15, P < 0.05; collagen type I expression, GTW group 1.68+/-0.31 vs. control group 2.06+/-0.24, P < 0.05], moreover, significantly reduced the glomerular expression of mRNA for collagen type 1(53.5% to the control group, P < 0.05)and TGF-beta(14.7% to the control group, P < 0.05)on day 42day.

CONCLUSIONGTW can not only decrease proteinuria, but also ameliorate mesangial alterations probably by the reduction of cytokines. GTW may be a promising agent for the prevention of progressive and irreversible glomerulosclerosis.

Actinin ; metabolism ; Animals ; Collagen Type I ; biosynthesis ; genetics ; Female ; Glomerular Mesangium ; metabolism ; pathology ; Glomerulonephritis, Membranoproliferative ; metabolism ; pathology ; Glycosides ; isolation & purification ; pharmacology ; Plants, Medicinal ; chemistry ; Proteinuria ; drug therapy ; RNA, Messenger ; biosynthesis ; genetics ; Rats ; Rats, Wistar ; Transforming Growth Factor beta ; biosynthesis ; genetics ; Tripterygium ; chemistry

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma* ; Biopsy ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Mucosa ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis*