Common channel syndrome--diagnosis with endoscopic retrograde cholangiopancreatography and surgical management

Six patients with intermittent bouts of vomiting, fever, abdominal pain, and jaundice beginning in infancy or early childhood were all demonstrated by endoscopic retrograde cholangiopancreatography to have an anomalous junction of the pancreaticobiliary ductal system with the formation of a characteristic long common channel. A varying degree of dilatation of the bile duct also was noted. Resection of choledochus followed by hepaticoduodenostomy was performed with satisfactory results invariably in all cases. The existence of a pathologic entity that might reasonably be designated "common channel syndrome" is discussed with some comments on its relationship with dilatation of the bile duct (choledochal cyst) as well as on the recommendable method of surgical treatment.

3H-imipramine uptake into rat striatal slices and imipramine-induced 3H-dopamine efflux

The effect of imipramine on spontaneous efflux of radiolabelled dopamine (DA) from slices of rat striatum was examined by a superfusion method. Imipramine at concentrations of 10 - 100 microM enhanced the efflux of DA accumulated in a high-affinity uptake system in a concentration-dependent manner. This efflux of 3H-DA was not affected by conditions (Ca2+-free medium, 100 microM bretylium and 30 microM tetrodotoxin) which inhibited the release of 3H-DA by electrical stimulation. Furthermore, this imipramine-induced 3H-DA efflux was temperature-dependent. The uptake of 3H-imipramine into striatal slices was determined. This uptake was concentration- and temperature-dependent and increased linearly. These results are discussed in relation to the hypothesis that 3H-DA efflux by imipramine is connected with uptake of imipramine.

Effect of acid perfusion of the terminal ileum on plasma immunoreactive secretin and pancreatic secretion in the rat

The distribution of immunoreactive secretin in acid extracts of the alimentary tract of the rat was determined. It was found to be contained in higher concentrations in the duodenum and in the terminal ileum than in other parts of the intestine. To elucidate the possible role of secretin contained in the terminal ileum, this part of the intestine was perfused with hydrochloric acid, a potent secretin secretagogue, and changes in plasma immunoreactive secretin levels and in pancreatic secretion were investigated in anaesthetized rats. Plasma immunoreactive secretin was increased from 65 +/- 5 pg/ml to 108 +/- 13 pg/ml during a 10 minutes perfusion with hydrochloric acid. This was significantly higher than that of saline perfusion but significantly lower than that of duodenal perfusion with hydrochloric acid. Acid perfusion of the terminal ileum also caused a three-fold increase in pancreatic flow rate and a twofold increase in bicarbonate concentration. These results suggest that the terminal ileum, through release of secretin, might play a role in regulating the pancreatic secretion of water and bicarbonate in response to changes in intraluminal fluids in the distal intestine in the rat.

Temporal bone histopathology of atresia auris congenita with chromosome aberration

Temporal bone findings in two infants demonstrating congenital aural atresia with microtia were presented focusing mainly on the external and middle ears. These two cases were proved to have chromosome aberration that is, 13-15 trisomy and extra chromosome in group G individually. Temporal bones showed the multiple anomalies through the external, middle and internal ears. The external canals were filled with connective tissue in one case and with bony plate in the other to form aural atresia. There were no development of the tubotympanic recess in a case of 13-15 trisomy. The oval window area in both cases was poorly developed resulting in a connective tissue fissure in the lateral wall of the vestibule except for one ear, while the round windows were normally formed in all ears. The facial nerves showed an abnormal running course without forming the geniculate ganglion and the horizontal segment. These findings indicate that the structures derived from the second branchial arch might be more deeply involved than the first one in the congenital aural atresia.

Anomalies of the auditory organ in Potter's syndrome. Histopathological findings in the temporal bone

Histopathological findings in the temporal bone are described in a newborn infant, diagnosed as having Potter's syndrome. The infant has severely malformed low-set ears bilaterally and a small lower jaw; autopsy findings showed bilateral renal agenesis and pulmonary hypoplasia. The temporal bone indicated the deformities of the inner ear, classified as Mondini-type, complicated by extensive deformities to the external ear and middle ear, including absence of auditory ossicles, atresia of the oval window, abnormal course of the facial nerve, and hypoplastic external auditory canal. The cochlear membranous labyrinth showed nearly normal form in the upper turn, but severe hypoplasia in the basal turn, which was an unusual cochlear anomaly.

Effect of intraduodenal load of endogenous acid on secretin release in patients with peptic ulcer

In order to explore secretory mechanisms in peptic ulcer, the plasma secretin response to an intraduodenal load of gastric acid stimulated with tetragastrin was studied in 10 patients with duodenal ulcer, nine with gastric ulcer, and five young healthy volunteers. After the injection of tetragastrin plasma secretin level was significantly increased in all subjects. The integrated incremental secretin output significantly correlated with the incremental acid output in the duodenal ulcer group as well as the gastric ulcer group. THere was no significant difference in the integrated incremental secretin output among the three groups. However, the integrated incremental secretin output per unit amount of gastric acid loaded in the duodenum was significantly lower in the duodenal ulcer group than in the other two groups. These results suggest that in patients with duodenal ulcer the secretin release in response to an intraduodenal load of endogenous acid is impaired.

Fibrous histiocytoma of the nasal cavity and maxillary sinus

Two cases of fibrous histiocytoma were presented; Case 1: a 46-year-old man with a tumor filling the left nasal cavity and maxillary sinus, and Case 2: an 80-year-old man with a tumor of the right maxillary sinus destroying its surrounding wall. Histologically, the former was dominated by storiform pattern and onion-like structures, and the latter by osteoclast-like multinucleated giant cells. After radical surgery, Case 1 was free of recurrence for more than one year, and Case 2 showed recurrence although still maintaining fairly good health. A total of 29 cases hitherto reported arising in the nasal, paranasal and nasopharyngeal regions were reviewed, pitfall of differential diagnoses was commented especially in our two cases, criteria of malignancy were discussed, and the necessity of repeated samplings was emphasized because of paucity and unfamiliarity of fibrous histiocytoma arising, in particular, from the upper respiratory tract.

[Clinical studies with cefmenoxime in the otorhinolaryngeal field (author's transl)]

We conducted a therapeutic trial with cefmenoxime in the field of otorhinolaryngology on a total of 14 subjects including 7 cases of otitis media, 5 cases of peritonsillar abscess, 1 case of chronic sinusitis and 1 case of congenital aural fistula. 1. The effective rate for peritonsillar abscess was extremely high being judged 'markedly effective' in 3 cases and 'effective' in 2 cases. 2. The effective rate for otitis media was also remarkably high; it was judged effective in 85.7% of the cases. It is thought that this is probably due to the fact that therapy and supervision were carried out on inhospital patients. 3. The 1 case of chronic sinusitis and the 1 case of congenital aural fistula were each judged 'effective' and 'markedly effective'. The only side effect observed was a slight case of skin eruption in 1 of the patients.

Effect of imipramine on high potassium evoked 3H-dopamine release in the rat striatum

The effects of three different types of dopamine (DA) uptake inhibitor, imipramine, cocaine and nomifensine, were examined on high potassium evoked 3H-DA release using tissues obtained from rat striatum by a micropuncture technique. Imipramine caused an increase in 3H-DA efflux and this imipramine-induced efflux is Ca2+-independent. Moreover, imipramine reduced the high potassium evoked release, and at 50 microM, the release by potassium stimulation was entirely abolished. These results support that imipramine depletes vesicular DA which is released by potassium stimulation as well as an inhibitory effect on DA uptake. However, nomifensine dose not have such an effect.

An adenosquamous carcinoma of the male urethra with hypercalcemia

A case of primary adenosquamous carcinoma of the urethra observed in a 52 year old man is described. The patient had a history of recurrent scrotal abscess for seven and one-half months following trauma to the region. The serum calcium level was found to be elevated when carcinoma was diagnosed. The calcium level returned to normal after resection of the lesion but rose again when local recurrence and metastasis developed. He died three and one-half months after the surgery.

Histopathologic study of congenital aural atresia in the human embryo

We studied the histopathologic features of the temporal bones in a human embryo with unilateral aural atresia. The developmental stage of the embryo was at stage 22 in the Carnegie system, and the estimated ovulation age was 8 weeks. There were severe hypoplastic changes in Meckel's and Reichert's arch cartilages without differentiation of the auditory ossicles, hypoplasia of the tubotympanic recess, and resultant abnormal passing of the facial nerve in the affected ear. Abnormal lateral extension of the cartilaginous otic capsule replaced a posterior half of the middle ear region and seemed to form the so-called atresia plate. The external and middle ears of the unaffected side and the bilateral inner ears were morphologically normal. These findings might explain some parts of the complicated mechanism in the development of middle ear anomalies encountered in surgery for congenital aural atresia.

Temporal bone histopathology of necrotizing external otitis. A case report

Histopathological examination of the temporal bone of an individual with necrotizing external otitis revealed severe inflammation with necrosis in the subcutaneous granulation tissue in the external auditory canal. Erosion of the bony walls of the canal had created a defect in the anterior wall, through which infection spread to the preauricular region. The lateral part of the middle ear cavity was also filled with granulation tissue and purulent exudate. A dehiscence of the horizontal portion of the facial canal had apparently allowed spread of an inflammatory round cell infiltrate along the facial nerve up to the fundus of the internal auditory canal. The only evidence of inner ear pathology was the presence of eosinophilic fluid material in the perilymphatic spaces of the labyrinth. A review of other reports of cases of necrotizing external otitis seems to show that this is the only instance of this disease in which infection spread from the external canal through the tympanic membrane to the middle ear and thence to the internal auditory canal.

"Common channel syndrome"--anomalous junction of the pancreatico-biliary ductal system

A 7-year-old girl with a 3-year history of intermittent bouts of abdominal pain and jaundice underwent endoscopic retrograde cholangio-pancreatography, which revealed an anomalous junction of the pancreatico-biliary ductal system (bile duct dilatation being virtually non-existent). These abdominal symptoms being considered to be attributable to the anomaly, resection of choledochus followed by hepatico-duodenostomy was performed. Now, one and a half years after operation, the patient is entirely asymptomatic. The legitimacy of "common channel syndrome" as an independent pathologic entity was proposed and the necessity of surgical treatment in its successful management was stressed.

Rhodamine 6G, inhibitor of both H+-ejections from mitochondria energized with ATP and with respiratory substrates

Rhodamine 6G inhibited ATP hydrolysis by oligomycin-sensitive ATPase, purified from rat liver mitochondria, in good accord with the dose-response curve for its inhibition of energy transduction of ATP synthesis in mitochondria, but it did not inhibit ATP hydrolysis by purified F1. Rhodamine 6G also inhibited both H+-ejections from mitochondria energized with respiratory substrates and with ATP. The present findings show that the inhibitory effect of rhodamine 6G on energy transduction is not due to a modification of the transport system for adenine nucleotides, Pi, and respiratory substrates, and that the inhibition sites of rhodamine 6G are on components related with H+-ejection by redox components and also on F0.

Congenital pericardial defect associated with cardiac incarceration: case report

1. A 4-year-old boy with the congenital partial defect of the left pericardium who presented with myocardial infarction, died of incarceration of the left ventricle. 2. This is the fourth reported case of death from this anomaly in the world. 3. Because this anomaly occasionally causes sudden death, it is important to diagnose the condition while the patient is alive.

Anisotropic inhibition of energy transduction in oxidative phosphorylation in rat liver mitochondria by tetraphenylarsonium

Tetraphenylarsonium (TPA+) inhibited energy transduction in oxidative phosphorylation in mitochondria but not in submitochondrial particles, which are inside-out relative to the membranes of mitochondria. TPA+ incorporated into the inside of submitochondrial particles inhibited ATP synthesis in the particles. TPA+ also inhibited the reduction of NAD by succinate coupled with oxidation of succinate by O2 and hydrolysis of ATP. Energization of mitochondrial inner membranes with succinate and with ATP induced binding sites on the membranes for TPA+. The amounts of energy-dependent binding sites for TPA+ on mitochondria energized with succinate and with ATP, respectively, were 90 and 13 nmol/mg of protein. TPA+ also caused shrinkage of mitochondria energized with succinate and with ATP in an energy-dependent fashion. The energy-dependent binding of TPA+, TPA+-induced H+-ejection, TPA+-induced shrinkage of mitochondria, and TPA+-induced inhibition of energy transduction occurred in parallel. The present findings show that TPA+ inhibits energy transduction by binding to negative charges created on lipophilic domains near the surface of the outer side (C-side) of the mitochondrial inner membranes, and that it has no inhibitory activity on the inner side (M-side) of the membranes.

Teratogenic effects of combined administration of ethylenethiourea and nitrite in mice

Teratogenic potential of ethylenethiourea (ETU) was investigated in SLC-ICR mice after its reaction with sodium nitrite. ETU was given orally in doses of 400 mg/kg on various days of pregnancy in combination with 200 mg/kg NaNO2 at varied intervals. When NaNO2 was given to females immediately after their treatment with ETU on day 6 or 8 of pregnancy, fetal survival was significantly decreased. Various types of malformations were observed in the living fetuses from mothers treated on day 6, 8, or 10 of pregnancy, but not on day 12. The teratogenicity disappeared when NaNO2 was given 2 h after the treatment with ETU.

Dominant lethal mutation induced in male rats by 1,2-dibromo-3-chloropropane (DBCP)

1,2-Dibromoethane (DBE) and 1,2-dibromo-3-chloropropane (DBCP), soil fumigants, were investigated for their potential mutagenicity by dominant lethal studies in the rat and mouse. Dominant lethal mutation was induced by DBE in neither of the species. DBCP, on the other hand, induced dominant lethals in rats in the post-meiotic stage of spermatogenesis, especially in the early spermatid stage. However, DBCP did not cause dominant lethals in mice.

Anti-inflammatory activity of a proteolytic enzyme, Prozime-10

Prozime-10 (P-10), a proteolytic enzyme extracted from cultured broth of Aspergillus melleus, was injected intravenously into rats in dosages of 1--10 mg/kg and was found to alleviate carrageenin edema. Thermal denaturation diminished not only the proteolytic activity but also the antiedematous effect. Carrageenin-induced granuloma pouches in rats were reduced by P-10 in a dose-dependent manner (1--5 mg/kg). With P=10 (5 mg/kg i.v.), adjuvant arthritis was inhibited by 62% in the primary phase and by 57% in the secondary phase. Serum concentration of immunoprecipitable P-10 reached 100 mg/l within 30 min after the intraduodenal administration of P-10 (200 mg/kg) and was concomitant with a 3-fold increase in the blood esterolytic activity. When P-10 was injected (5 mg/kg i.v.) into rats, the plasma corticosterone level increased to a maximum of 4 times the preinjection level. These observations indicate that: (a) P-10 can be absorbed from the gut in sufficient quantities to bring about anti-inflammatory activity, and (b) the anti-inflammatory activity of P-10 can be related, in part, to the ability of P-10 to affect the release of glucocorticoids.

Sinus histiocytosis with massive lymphadenopathy in a Japanese adult with unusually elevated EBV antibody titers

A 35-year-old Japanese male was presented with massive lymphadenopathy in bilateral preauricular and submandibular regions for five years' duration without any complaints despite of no specific treatments. Laboratory examinations revealed neurtrophilia, elevated BSR, hypergammaglobulinemia with elevated IgG and IgM, positive CRP and RA, low percentage of T-cells in peripheral blood, impaired PHA blast transformation, and elevated EBV titers against viral capsid, early and nuclear antigens. Biopsy specimens demonstrated massive histiocytosis with hemophagocytosis in the sinuses and predominant mature plasma cells in the medulla, which were fairly well consistent with "sinus histiocytosis with massive lymphadenopathy" (ROSAI and DORFMAN). Ultrastructural study revealed histiocytes exhibiting avid phagocytosis of blood cells, epithelioid histiocytes with poor phagocytic activity, foamy storage histiocytes loaded with a large number of osmiophilic lipid granules and giant cells of various types. Pathogenesis of this apparently benign disease entity was briefly discussed, and its refractoriness against any specific therapy was emphasized.

Dose-effect of inorganic tin on biochemical indices in rats

The dose-effect of stannous chloride on biochemical indices was examined in weanling male rats given oral doses of 0.3, 1.0 and 2.0 mg/kg at 12-h intervals for 90 days. The 3.0 mg/kg dose caused significant decreases of the relative weights of the femur, calcium concentration, lactic dehydrogenase and alkaline phosphatase activities in the serum, succinate dehydrogenase activity in the liver, and calcium content and acid phosphatase activity in the femoral diaphysis and epiphysis. Of the above indices, the 1.0 mg/kg dose produced significant reduction of succinate dehydrogenase activity in the liver, and calcium content and acid phosphatase activity in the femoral epiphysis. Those significant decreases were not observed with the 0.3 mg/kg dose, although a slight but not significant decrease of calcium content in the femoral epiphysis was observed. These results suggest that the no-effect level of inorganic tin orally administered would be lower than 0.6 mg/kg/day.

Vascular anatomy of the inner ear of the guinea pig--a sem study of the corrosion cast--

This paper shows a casting method of the vascular system of the inner ear of the guinea pig with the use of fluid resin injected intravascularly and the observation of those specimens by means of the scanning electron microscopy. First, fluid resin was injected into the blood vessels of a live or just sacrificed guinea pig. After taking the temporal bone out of the animal, it was decalcified and macerated completely. Then, a cast of the inner ear vessels was taken and observed with a scanning electron microscope. A pair of photos differing in teh view angle by seven degrees were taken simultaneously, and observed with a stereoviewer. This technique brought photographs of well magnified three-dimensional construction of the inner ear blood vessels.

The cytologic manifestations of lymphomatoid granulomatosis in cerebrospinal fluid. A case report

The cytologic manifestations of lymphomatoid granulomatosis in the cerebrospinal fluid observed in a 50 year old white male with midbrain and spinal cord involvement are presented. The cerebrospinal fluid, obtained by cisternal puncture, contained predominantly undifferentiated medium-sized cells, which were retrospectively interpreted as reticular cells, These cells were characterized by an atypical nucleus with one or more prominent nucleoli and clumped chromatin granules, abundant cytoplasm and frequent amoeboid protrusions of the cytoplasmic membrane. Small numbers of undifferentiated plasmacytoid cells, lymphocytes, neutrophils and erythrocytes were evident. A few mitoses were also observed. These cellular characteristics are correlated with histology of the parent lesion in the midbrain obtained at the postmortem examination.

Changes in T cell population in patients with bronchogenic carcinoma

Absolute numbers of T cells were measured in a series of 84 patients with bronchogenic carcinoma and were compared with T cell percent with regard to clinical stage, course, and histologic type. Although T cell percent declined in accordance with the advancement of stage, the differences between the stages were not statistically significant. On the other hand, the absolute number of T cells decreased prominently in Stages III and IV as compared to Stages I and II (p less than 0.05 between Stages I and III, P less than 0.001 between Stages I and IV, and p less than 0.05 between Stages II and IV). Likewise in patients who were followed serially after resection, the absolute number of T cels correlated well with the postoperative course. These results lead us to the conclusion that it is more useful estimate the absolute T cell count rather than T cell percentage in lung cancer.

Histological development of stapes footplate in human embryos

Normal development of the human stapes footplate was investigated in serial sections by light microscopy. Materials were obtained from 35 Japanese embryos from the 6th to 32nd week of embryonal age. Eighteen embryos up to 16 weeks of age (3.5mm to 105mm in crown-rump length) were examined, focusing particularly on the lamina stapedialis of the otic capsule. The present study showed that primordial formation of the lamina stapedialis appeared in 16mm embryo and that the lamina was completely formed and fused to the base of the annular stapes in a 35mm embryo. In a 50mm embryo, the adult form of stapes was found with a rim and annular ligament. The results, therefore, seemed to essentially agree with the theory of dual origin and development of the footplate proposed by Cauldwell and Anson, and teratogenic agents might affect any stage of the process producing anomalies, including congenital footplate fixation, congenital absence of the oval window and calcification of the annular ligament.

Norepinephrine-producing tumors of bilateral breasts: a case report

There was a tumor in the left breast which was suspected to be carcinoid tumor at excisional biopsy. Autopsy revealed the same tumor in the right nipple. In the cells of the bilateral tumors a number of argylophil granules were diffusely demonstrated and the neurosecretory ones were verified electronmicroscopically. In the urine of the patient a moderate amount of norepinephrine was excreted. It was presumed that the norepinephrine might have been produced from the breasts. In the literature reviewed, the case of breast carcinoid has not been reported previously.

Hepatolienal fusion: case report of an unusual lesion

A unique fusion of liver and spleen was observed at autopsy between a tongue of hepatic parenchyma and the superolateral aspect of the spleen in an adult Caucasian male. No instance of hepatolineal fusion was found in the literature, prompting this report. An embryologic explanation is offered.

The embedding of ossicular chain specimens in plastic

The following objects were specifically designed for teaching material to the medical students. Dried human auditory ossicles were bleached in 30% hydrogen peroxide solution and then, embedded in a good quality plastic. The plastic mass was shaped into a ball 5 cm in diameter, and the surface of which was polished with a good finish. The merits of the objects may be listed as follows; 1) A permenant preservation of the objects is possible because they are embedded in heat- and chemical-resistant material. 2) The objects are handy for use in the lecture room and easily observed by the students because of the magnifying effect of the plastic covering.

Atypical fibrous histiocytoma of the humerus: a light and electron microscopic study

A unique osseous tumor, which arose in the humerus of a 44-year-old white man, is reported. The lesion was designated atypical fibrous histiocytoma because of the absence of atypical mitoses despite prominent nuclear pleomorphism of tumor cells. The tumor was composed mainly of spindle cells, tightly packed in a storiform pattern. Clear histiocytes and tumor giant cells were occasionally seen. Toward the proximal and distal ends, the tumor showed increasing fibrogenesis, and the ends were composed of areas of packed clear histiocytes and acellular myxoid matrix with focal calcification. Ultrastructurally, five cell types comprised the tumor, but fibroblast-like cells predominated. Histiocyte-like, xanthomatous, giant and undifferentiated cells were observed only occasionally. The patient has been followed for five years after disarticulation without developing evidence of distant metastasis.