BACKGROUND: Acquired retinal macroaneurysms are round dilatations of retinal arterioles that occur in the posterior fundus. They tend to rupture before they grow large and cause a visual decrease. The average diameter of macroaneurysms in the previous reports is 281 micrometer. METHODS: A 63-year-old man complained of a sudden decrease of visual acuity in the left eye. Fundus examination of his left eye revealed a large protruded mass, 2 disc diameters in size, at the first bifurcation of the inferotemporal retinal artery. Preretinal vitreous bleeding and serous retinal detachment were observed around the lesion. Indocyanine green (ICG) angiography showed this mass to be continuous with the inferotemporal retinal artery and ICG dye leaked from the retinal artery into the lumen of the mass, with pulsation. RESULTS: Six months later, the large macroaneurysm underwent spontaneous involution. CONCLUSION: As shown in this patient, retinal macroaneurysms may grow extremely large. ICG angiography was useful to diagnose this large retinal arterial macroaneurysm.

Aneurysm↗

PubMed2000

[Peripapillary fluorescein angiographic findings in non-glaucomatous eyes].

PURPOSE: In fluorescein angiography (FAG), glaucomatous eyes show a zone of no fluorescence around the disc and hyperfluorescence indicating serum diffusion at the margin of the zone, which play some role in glaucomatous optic nerve damage. But detailed FAG findings have not been reported in non-glaucomatous eyes. We conducted a study to investigate whether peripapillary FAG findings in glaucomatous eyes were specific to glaucoma or not. MATERIALS AND METHODS: 46 eyes of 46 subjects were selected by some reservations from all the non-glaucomatous patients undergoing FAG in 1996. We studied FAG films and measured the zone of no fluorescence adjacent to the disc (non-fluorescent zone). RESULT: 44 eyes (95.6%) showed a non-fluorescent zone. The non-fluorescent zone was clearly wider in temporal sectors than nasal sectors, and its width was related to the refraction. There were two types of non-fluorescent zone, one showing hyperfluorescence from the outer boundary of the zone in the late phase, and the other showing hyperfluorescence from the disc margin. The width of the non-fluorescent zone in the former type was wider than in the latter type. These results are similar to the findings in glaucomatous eyes. CONCLUSION: These findings suggest that not only glaucomatous eyes but also non-glaucomatous eyes have a variety of histological structures and serum diffusion around the disc.

Adolescent↗

PubMed1999

Examination of nodal metastases by a clearing method supports pelvic plexus preservation in rectal cancer surgery.

PURPOSE: In rectal cancer surgery preservation of urinary and sexual function is attempted by means of operations preserving the autonomic nerves of the pelvic plexus. Emergence of residual cancer because of a more shallow plane of dissection is a problem of concern with these methods, so we examined indications for pelvic plexus preservation. METHODS: We studied 198 patients with rectal carcinoma who underwent abdominopelvic lymphadenectomy. Lymph nodes along the superior hemorrhoidal artery and middle hemorrhoidal artery medial to the pelvic plexus were defined as perirectal nodes, and nodes along the middle hemorrhoidal artery lateral to the pelvic plexus and along the internal iliac artery represented lateral intermediate nodes. Node metastases were examined by the clearing method. RESULTS: Metastasis to perirectal nodes occurred in 12.5 percent in patients with pT1 tumors, 28.9 percent of those with pT2 tumors, and 50.0 percent of those with rectosigmoid junctional cancer. Metastasis to lateral intermediate nodes was absent in patients with pT1 or pT2 tumors and was as low as 2.5 percent in patients with rectosigmoid junctional cancer. CONCLUSIONS: In patients with T1, T2, and rectosigmoid junctional cancer, perirectal node dissection is necessary, but chances of residual cancer should remain minimal when the pelvic plexus is preserved.

Humans↗

PubMed1999

Horizontal inclination of the longitudinal axis of the colonic J-pouch: defining causes of evacuation difficulty.

PURPOSE: Functional outcome after low anterior resection for rectal cancer is improved by the construction of a colonic J-pouch. One disadvantage of this type of reconstruction is evacuation difficulty, which has been associated with large pouches. The purpose of this study was to elucidate the causes of evacuation difficulty in large pouches using pouchography. METHODS: The angle between the longitudinal axis of the pouch and the horizontal line (pouch-horizontal angle) on lateral pouchography was determined in 26 patients with 10-cm J-pouch reconstructions (10-J group) and 27 patients with 5-cm J-pouch reconstructions (5-J group). Measurement were made at three months, one year, and two years after surgery. Clinical function was evaluated using a questionnaire one year postoperatively. RESULTS: The pouch-horizontal angle in the 10-J group was significantly smaller than that in the 5-J group at all three time points. In both groups the pouch-horizontal angle at one year was significantly smaller than that at three months. There were no significant differences between the pouch-horizontal angles at one and two years. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group. CONCLUSIONS: The evacuation difficulty observed in patients with large colonic J-pouch reconstructions may be attributed to the development of a horizontal inclination within one year of surgery.

Adult↗

PubMed1999

Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty.

PURPOSE: Although the functional outcome after low anterior resection for rectal cancer using colonic J-pouch reconstruction is superior to that using conventional straight reconstruction, the one drawback of colonic J-pouch reconstruction is difficulty with evacuation. Recently it has been suggested that construction of a larger colonic J-pouch causes the evacuation difficulty. The purpose of this study was to elucidate the cause of evacuation difficulty with colonic J-pouch reconstruction. METHODS: We compared pouchography of 26 patients with 10-cm colonic J-pouch reconstructions (10-J group) and 27 patients with 5-cm colonic J-pouch reconstructions (5-J group) at three months, one year, and two years after surgery. Functional assessments were performed one year postoperatively. Clinical function was evaluated using a questionnaire. Evacuation function was evaluated by the balloon expulsion and saline evacuation tests. RESULTS: The greatest width of the pouch in the 10-J group in the anteroposterior view was significantly greater than that in the 5-J group at all three measurement times (3 months, 4.9 vs. 4 cm; P = 0.0011; 1 year, 9 vs. 5.6 cm; P < 0.0001; 2 years, 9.2 vs. 5.8 cm; P < 0.0001). The value in the 10-J group at one year after surgery was 1.9 times that at three postoperative months; in the 5-J group this ratio was 1.4. There was a significant difference between these ratios (P < 0.0001). No significant difference existed between the values at two years and one year after surgery in either the 10-J or the 5-J group. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group. Evacuation function in the 10-J group was significantly inferior to that in the 5-J group. CONCLUSIONS: The evacuation difficulty observed in patients with larger colonic J-pouch reconstructions is associated with excessive distention of the pouch occurring within one year of surgery.

Adult↗

PubMed1999

Detection of a rectocele-like prolapse in the colonic J-pouch using pouchography: cause or effect of evacuation difficulties?

The functional outcome after a low anterior resection for rectal cancer is improved by a colonic J-pouch reconstruction. One functional problem with J-pouches is difficulty in evacuation, which is more common with large reconstructions. Since rectoceles are common findings on defecography in patients with evacuation difficulties, we proposed that a rectocele-like prolapse may be thus found in patients with large J-pouches. Pouchography was used to identify a rectocele-like prolapse (RP) in 26 patients with a 10-cm J-pouch (10-J group) and 27 patients with a 5-cm J-pouch (5-J group). Pouchography was performed at 3 months, 1 year, and 2 years after surgery. Functional assessments were performed 1 year postoperatively. Clinical function was evaluated using a questionnaire. The evacuation function was evaluated by the balloon expulsion and saline evacuation test. No patients had an RP at 3 months or 1 year after surgery. An RP was significantly more common in the 10-J group than in the 5-J group at 2 years after surgery (P = 0.0374). An evacuation difficulty was significantly more common in the 10-J group than in the 5-J group. The evacuation function in the 10-J group was also significantly inferior to that in the 5-J group. An RP appearing 2 years after surgery is more common in patients with evacuation difficulties and large colonic J-pouch reconstructions.

Aged↗

PubMed1999

Coloanal anastomosis using a circular stapling device following perineal rectosigmoidectomy for rectal prolapse.

Perineal rectosigmoidectomy with a hand-sewn anastomosis is thought to be the most appropriate procedure for elderly patients deemed unfit to tolerate a major abdominal operation. However, the use of a circular stapling device to perform the coloanal anastomosis following rectosigmoidectomy shortens the operative time and provides a more secure anastomosis than the traditional hand-sewn technique.

Anal Canal↗

PubMed1999

High ligation of the inferior mesenteric artery with hypogastric nerve preservation in rectal cancer surgery.

We describe herein a technique of performing upward node dissection following high ligation of the inferior mesenteric artery for patients with T3 and T4 rectal carcinomas. The course of the hypogastric nerve is confirmed macroscopically during the procedure to ensure its preservation. This technique offers both increased radicality and the prevention of ejaculatory dysfunction.

Digestive System Surgical Procedures↗

PubMed1999

Cooling effect on excimer laser photorefractive keratectomy.

PURPOSE: To evaluate the effect of cooling on pain, corneal haze, and refractive outcome after excimer laser photorefractive keratectomy (PRK). SETTING: Tokyo Medical and Dental University Hospital, Tokyo, Japan. METHODS: The corneal surface was cooled before, during, and after laser ablation using a method called cooling PRK. Thirty-eighty highly myopic eyes of 38 patients whose spherical errors ranged from -8.00 to -18.75 diopters (D) were randomized into 2 groups: 16 eyes with conventional PRK and 22 eyes with cooling PRK. Postoperative pain was measured using the Visual Analogue Scale (VAS). Refraction, visual acuity, and complications were followed for up to 2 years. All data were analyzed and compared between groups to evaluate the cooling effect on PRK. RESULTS: One day postoperatively, patients in the cooling PRK group had significantly less pain (P < .01). At 3 months, the haze score in the cooling PRK group was significantly less than in the conventional PRK group (P < .01). The residual refractive error was not significantly different between the 2 groups until 2 years, when it was greater in the conventional PRK (mean -5.09 D +/- 2.11 [SD]) than the cooling PRK group (-4.64 +/- 2.27 D). Ten eyes (62.5%) in the conventional PRK group and 15 eyes (68.2%) in the cooling PRK group were within +/- 1.00 D of the intended refraction. There were no serious complications in the cooling PRK group. Two eyes in the conventional PRK group had severe corneal haze and lost 2 Snellen lines of best corrected visual acuity. CONCLUSION: Corneal cooling on PRK effectively reduced postoperative pain, corneal haze, and myopic regression.

Adult↗

PubMed1999

Effect of nicotine on type 2 deiodinase activity in cultured rat glial cells.

Intracellular generation of triiodothyronine (T3) from thyroxine (T4) by type 2 deiodinase (D2) in the mammalian brain, plays a key role in thyroid hormone action. The presence of D2 in rat astrocytes suggests the importance of glial cells in the regulation of intracellular T3 levels in the rat central nervous system (CNS). To analyze further the factors that regulate D2 activity in the CNS, we investigated the effects of nicotine and of mecamylamine, which inhibits the binding of nicotine with nicotinic acetylcholine receptors, on D2 activity in cultured mixed glial cells of the rat brain. We incubated cultured mixed glial cells obtained from neonatal Wistar rats in the presence of 10 mM dithiothreitol, 2 nM [125I] reverse T3 and 1 mM 6-N-propyl-2-thiouracil for 2 h at 37 degrees C, and the released 125I- was counted in a gamma counter. D2 activity of cultured cells was dependent on the temperature and the amount of protein. The basal D2 activity of rat mixed glial cells was 1.9 +/- 0.2 fmol of I- released/mg protein/h (mean +/- SEM). The addition of 10(-11), 2 x 10(-11), 10(-10), and 10(-9) M nicotine significantly increased D2 activity to approximately 2.2-, 2.4, 3.5- and 2.9-fold the basal level, respectively. D2 activity stimulated by 10(-8) M nicotine (2.5-fold) reached a peak after 9 h incubation. The stimulatory effect of nicotine was completely blocked by 10(-6) M mecamylamine. In conclusion, nicotine increases D2 activity probably via nicotinic acetylcholine receptors, and may influence brain function, at least in part, by affecting thyroid hormone metabolism.

Animals↗

PubMed1999

Effect of streptozotocin-induced diabetes mellitus on type 1 deiodinase (D1) in inherited D1-deficient mice.

We investigated the effects of streptozotocin (STZ)-induced diabetes on thyroid hormone levels, type 1 deiodinase (D1) activity and messenger RNA (mRNA) levels in inherited D1 deficient C3H mice in a comparative manner with control C57 mice. The apparent maximum velocity (Vmax) D1 values in C3H mice were 3% (liver) and 26% (kidney) of those in C57 mice. In C3H mice, similar serum T3, slightly higher T4, and 2.6-fold higher rT3 levels were observed compared with C57 mice. In STZ-induced diabetes, serum T4 level markedly decreased in both C3H and C57 mice. Serum T3 levels in STZ-C3H mice similarly decreased as in STZ-C57 mice. On the other hand, serum rT3 levels increased to 3.3-fold higher in STZ-C3H than in STZ-C57 mice. The Vmax values were decreased to 12% (STZ-C3H) and to 30% (STZ-C57) in liver, and decreased to 33% (both STZ-C3H and STZ-C57) in kidney. The changes in D1 mRNA levels in diabetes versus control were comparable to those of D1 activities in both strains. In summary, similar mechanism(s) to those which decrease the D1 expression and the serum T3 level in diabetes, function in D1 deficient C3H mice as in C57 mice. It appears that hepatic and renal D1 activity alone can not explain the similar reduction in T3 level in STZ-C3H mice and STZ-C57 mice.

Animals↗

PubMed1999

[Clinical results and complications of refractive surgery].

PURPOSE: To evaluate the efficacy of photorefractive keratectomy (PRK) with a scanning type excimer laser MEL-60 (AESCLUP-MEDITEC, Co). SUBJECTS AND METHOD: We performed PRK on 102 eyes of 62 myopic patients whose refraction ranged from-3.00 to -12.50 D (mean, -6.47 D) and examined the clinical results of postoperative refraction and complications. RESULTS: At 12, 18, and 24 months after the operation, the mean refraction was -1.57 +/- 1.25D, -1.63 +/- 1.51 D and -1.73 +/- 1.47 D. At 12 months after the operation, 36 eyes (46.2%) were within +/- 0.5 D of intended correction, 61 eyes (78.3%) within +/- 1.0 D, and 76 eyes (97.4%) within +/- 2.0 D. Twenty-four months after the operation, 12 eyes (37.5%) were within +/- 0.5 D, 18 eyes (56.3%) within +/- 1.0 D and 29 eyes (90.6%) within +/- 2.0 D. The complications were as follows: keratitis filamentosa was observed in 10 eyes (10.5%), decrease of contrast sensitivity in 7 eyes (7.4%), subepithelial corneal haze in 4 eyes (1.2%), steroid-induced glaucoma was 2 eyes (2.1%), increase of astigmatism in 2 eyes (2.1%), decrease of best corrected visual acuity in 2 eyes (2.1%), and corneal ulcer in 1 eyes (1.1%). CONCLUSION: PRK with a scanning type excimer laser MEL-60 was effective to reduce refractive error in low and mild myopia, but there were some complications, so that a long, careful follow-up seems necessary.

Adult↗