Though various prosthetic materials have been experimented with for use as an artificial esophagus in the past, the two main problems that have prevented successful clinical implantation of such a prosthesis were anastomotic leakage and stricture formation of the artificial esophagus. The purpose of this study is to evaluate a high water content polyvinyl alcohol hydrogel (PVA-H) for use as the esophageal prosthesis. In 10 adult mongrel dogs, the defect after resection of the intrathoracic esophagus was bridged with a PVA-H esophageal prosthesis, 5.5 cm in length and 15 mm in internal diameter with two Tefron rings, installed 2 cm from each end. The esophageal prostheses, including the anastomotic lines, were enveloped by Dacron mesh after implantation. After implantation, the prostheses were examined endoscopically and fluoroscopically. The dogs, which were sacrificed or had died, were evaluated macro- and microscopically. Among the six dogs underwent operation, one is still living 900 days after implantation. The other two dogs were sacrificed on 165 and 162 days after implantation. The remaining three dogs died of postoperative complications ranging from 25 to 81 days after implantation. The causes of death were the respiratory insufficiency after endoscopical examination, abscess formation around the prosthesis and pyothorax. Up to 2 months after implantation the esophageal prostheses were fixed to the host esophagus without stenosis. However, the prostheses were gradually dislodged due to constricture depending on the growing granulation at the proximal anastomosis. When the surviving dog was examined on the 376th day after the operation, the esophageal prosthesis fell off entirely.(ABSTRACT TRUNCATED AT 250 WORDS)
Intramedullary spinal AVMs fed by the anterior spinal artery cannot be embolized without risking unacceptable motor deficits, since the feeding arteries may supply the corticospinal tract (CST). An 8-year-old boy underwent successful embolization of such an AVM under general anesthesia using intermittent infusion of embolic material with monitoring of the CST integrity with the corticospinal motor evoked potential (MEP). This case illustrates the value of corticospinal MEP monitoring during therapeutic procedures under general anesthesia which risk interrupting the blood supply to the CST.
The corticospinal direct (D) response to stimulation of the motor cortex exposed for intracranial surgery was recorded in 20 cases from wire electrodes inserted into the spinal epidural space. The D response was obtained from stimulation of restricted areas of the cerebral cortex, that is, the hand, trunk and thigh areas of the motor cortex. The D response was resistant to anaesthesia and unaffected by muscle relaxants. Thus, recordings of the D response are useful for identifying the location of the motor cortex during intracranial surgery under general anaesthesia.
Eight cases of a persistent vegetative state caused by brain damage were treated by chronic deep-brain stimulation (stimulation target: the mesencephalic reticular formation and/or non-specific thalamic nucleus) over a period of more than 6 months. Three of the patients are currently able to communicate and to express their demands by voice and one other patient has recovered very close to this state. These four cases showed changeable spectrograms with desynchronization on continuous EEG recording and all components of the BSR and SER could be recorded except for prolonged latency of both N20 (SER) and the V wave (BSR) 2 months after the initial coma. Following chronic deep-brain stimulation, EEG and behavioural arousal responses were observed with increased r-CBF, r-CMRO2 and r-CMRGL in the whole brain tissue. After 3-6 months of chronic deep brain stimulation, the prolonged coma scale rose in four of the eight cases and three cases emerged from the persistent vegetative state. Transmitter substances and their metabolites were also found to be increased in the CSF after chronic deep-brain stimulation. Based on these findings, chronic deep-brain stimulation represents a useful kind of treatment that can lead to emergence from a persistent vegetative state, if the candidate is selected by electrophysiological studies 2 months after the initial insult and if the stimulation is applied for more than 6-8 months using a high-safety chronic deep-brain stimulating instrument.
We studied the prevalence of manidipine-induced gingival overgrowth. The incidence of such overgrowth was 1%, and was found in only one case among the surveyed patients. Together with a review of the literature regarding the pathogenesis and clinical management of drug-induced gingival overgrowth, we describe a case of manidipine-induced gingival overgrowth.
