[Spread of surgical indication for hepatoma with postoperative transcatheter arterial infusion]

We evaluated the reduction surgery and the postoperative TAI for unresectable hepato-cellular carcinoma (HCC). Eight patients underwent reduction surgery and postoperative TAI (group I). Twenty-five patients underwent combination therapy with TAI, TAE, EI, hyperthermia and irradiation, who had not undergone reduction surgery (group II). Nine patients underwent a relative noncurative operation (group III). We studied the prognosis of these three groups.

RESULTS

The one-year survival rates were 85.7% in group I, 38.6% in group II and 55.5% in group III. The three-year survival rates were 42.9% in group I, 10.7% in group II and 55.5% in group III. There was a significant difference of prognosis between group I and group II (p less than 0.05, generalized Wilcoxon). These results suggest that reduction surgery and post operative TAI for unresectable HCC improve the prognosis.

Mitral regurgitation with gross deformity of a mitral leaflet due to Kawasaki disease

A 4-year-old girl had two episodes of Kawasaki disease which resulted in severe mitral regurgitation. She had not had any coronary arterial lesion during the acute phase of the illness, nor any myocardial ischemia. Severe destruction of the mitral leaflet was documented by two-dimensional echocardiography. It is suggested that this lesion was due to severe carditis and valvulitis which developed during the acute phase of the illness.

[A study of drinking habits of rural middle and old aged residents in Ibaraki Prefecture--relationship between problem drinking, depression and personality (Part 1). On male subjects]

Although there has been considerable research conducted regarding the relationship between alcohol dependency and clinical depression, there have been few reports which have investigated the relationship between alcohol consumption and depression in the general populace of residents of rural communities in Japan. We investigated this correlation in a rural community located in Ibaraki Prefecture, the findings of which are described in this report. The subjects of this investigation were residents of the southern part of the town of K in Ibaraki Prefecture age 40 and over, all of whom had participated in a medical examination program. With respect to the men surveyed, the proportions of problem drinkers and severe problem drinkers were 10.4% and 25.7%, respectively. According to the results we obtained with respect to correlation with personality, problem drinkers were found most frequently in shut-in personality types (37.5%). In regard to the correlation with depression, 7% of the problem drinkers and severe problem drinkers exhibited an SDS score of 50 or higher. In addition, the non-drinking group demonstrated a significantly higher degree of depression in comparison to the normal drinker and severe problem drinker groups.

Volume status and body composition of chronic dialysis patients: utility of bioelectric impedance plethysmography

We assessed the utility of bioelectric impedance plethysmography (BIA) for measuring acute volume changes and body composition in patients with renal disease. Chronic hemodialysis and peritoneal dialysis patients were evaluated before and after dialysis. Total body water, as measured by BIA, predicts body weight. Acute changes in body water, induced by dialysis, are not predicted well by data derived from BIA. Body fat (%) and fat-free mass (%), determined by anthropometry, are predicted well by body composition data derived by BIA. BIA is useful for assessing body composition in this population, but must be cautiously applied to the measurement of acute volume changes.

Morphological characteristics of the auricular blood vessels related to idiopathic pseudocyst of the auricle

We examined the actual circumstances of idiopathic pseudocyst of the auricle and morphological characteristics of the auricular vascular system, utilizing the serial sections of tissue blocks embedded in celloidin. While the origin of pseudocyst of the auricle is considered to have much to do with the vascular system, there are still many unknown factors regarding the auricular vascular system itself. The morphology of the proximal portion has been described in various documents, but the details have not yet been elucidated. In order to examine this, we made close observation of the auricular vascular system. The materials used consisted of eight auricles obtained from corpses for the anatomical dissection. Four auricles were macroscopically dissected and observed after being injected with dye into the vascular system, whereas the remaining four auricles were observed with a new staining process using the celloidin serial section method in which sections are alternatively stained with luxol fast blue-PAS-hematoxylin and modified Masson-Goldner stain. In the macroscopical observation of arteries being distributed in auricles, the arteries perforating the auricular cartilage mentioned in documents were not be confirmed. In the observation of the serial sections, capillary plexuses were able to be confirmed along the periphery, very close to the auricular cartilage. Pathohistological findings with regard to four cases of idiopathic pseudocyst of the auricles were examined and closely compared with the histological findings of normal cases. It was presumed that idiopathic pseudocyst of the auricles were caused by bendings or oppressions of auricles, which perhaps caused circulatory disturbance, leading ultimately to partial split of the auricular cartilage.

Formation and resolution of white matter oedema in various types of brain tumours

Following infusion of 200 ml of Iopamidol for 1 hour the propagation of extravasated contrast medium around different types of 12 brain tumours was examined and imaged via CT. Increasing volume of expanding peritumoural contrast enhanced brain tissue was measured by integrating volumes of planimetrically measured enhanced area on CT slice of 0.5 cm in thickness. So far our data failed to demonstrate differences in the peritumoural contrast expansion between the different types of tumours. Formation and resolution as well as the speed of oedema propagation were determined by calculation of the increasing volume of the enhanced peritumoural brain tissue. Average formation rate of oedema fluid from 1 cm3 of tumour was 0.06 ml/hr, and was lower in larger tumours, while formation rate of oedema fluid from whole tumour was higher in larger tumours. Average resolution rate of oedema fluid during the passage through 1 cm3 of the peritumoural white matter was 0.03 ml/hr, and was not affected by tumour size. Average speed of oedema propagation was 0.59 mm/hr, and was higher in larger tumours. The main therapeutic effect of steroid in peritumoural oedema was a reduction in formation rate of oedema fluid.

A highly sensitive sandwich enzyme immunoassay of urinary growth hormone in children with short stature, Turner's syndrome, and simple obesity

GH values were determined by a highly sensitive sandwich enzyme immunoassay in the 1st morning and/or 24-h accumulated urine samples in 94 children (short stature 70, including 14 with complete GH deficiency, 9 with partial GH deficiency, and 47 with GH-normal short stature; Turner's syndrome, 10, and simple obesity, 14). GH values were also determined in the 2nd to 4th urine samples taken on the same day together with the 1st morning urine in 5 of them. GH values in the 1st morning urine correlated significantly with those of the 24-h urine and with serum peak and mean GH values during nocturnal sleep as a physiological GH secretion test. The 2nd to 4th urines had lower GH concentrations than the 1st morning urine. The GH value of the 1st morning urine in complete GH deficiency was significantly lower than those in GH-normal short stature, partial GH deficiency and Turner's syndrome. However, no significant difference was detected in urinary GH values between complete GH deficiency and simple obesity. We conclude that 1st morning urinary GH estimation may be useful for differentiation of complete GH deficiency from other causes of short stature, but may be difficult for the distinction between complete GH-deficiency and obesity with normal GH secretory ability.

[Doppler echocardiographic estimates of pressure gradients in various types of stenoses: usefulness and limitations]

In the present study, the accuracy of Doppler estimates of pressure gradients in various types of stenoses was clinically and experimentally evaluated. Fifty-seven patients, including 23 with ventricular septal defect, 15 with aortic or pulmonary valvular stenosis, four with infundibular stenosis, and five with supravalvular aortic or pulmonary stenosis were observed. The peak systolic pressure gradient (dP (C] was obtained at the time of catheterization in all patients. Before catheterization, the maximum velocity was measured by pulsed or continuous Doppler echocardiography and the estimated systolic pressure gradient according to Doppler (dP (D] was calculated by the simplified Bernoulli equation. The experimental model was designed to create pulsatile flow through a stenosis model. Nine different stenotic model types were used, including three orifice-like stenoses and six truncated cones with heights of 10 mm and 20 mm distal to the stenosis. The orifices in their stenoses were 3, 4 and 5 mm, respectively. Glycerin solution containing Sephadex with a viscosity similar to that of blood was used as the circulation medium. Its specific gravity was 1.16 g/cm3. In each stenotic model, the maximum velocity and instantaneous systolic peak pressure gradient were measured at various water flow rates.

CLINICAL RESULTS

In patients with ventricular septal defect or valvular stenosis, dP (D) correlated very well to dP (C), with the regression equation, y = 0.87x + 2.79 (r = 0.92) or y = 0.96x + 1.02 (r = 0.99). In the other patients except for three with patent ductus arteriosus, dP (D) overestimated dP (C) by 11 to 71 mmHg, and their post-stenotic areas had gradually widened according to angiographic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diffuse axonal injury manifested as corpus callosum damage on magnetic resonance imaging. Case report]

A 26-year-old male was injured in a motorcycle accident and arrived unconscious at a local general hospital. Lack of improvement despite intensive care prompted his referral to the neurosurgical department, approximately 10 hours after the accident. On neurological examination his Glasgow Coma Scale score was 8, and mild right hemiparesis and right radial nerve palsy were noted. There was no skull fracture. Computed tomography disclosed intraventricular hemorrhage and small hemorrhagic foci in the prepontine area and the border between the gray and white matter. No hemorrhage was demonstrated in the corpus callosum. Magnetic resonance imaging (MRI) was performed 3 weeks after admission with a 0.5-tesla resistive Vista magnetic resonance scanner. The inversion recovery technique was used, with a repetition time (TR) of 2100 msec, an inversion time of 500 msec, and an echo time (TE) of 40 msec, for T1-weighted images. The spin-echo technique was used, with a TR of 2000 msec and a TE of 80 msec, for T2-weighted images. In the body and splenium of the corpus callosum, T1-weighted images showed a spotty area of low signal intensity with an irregular margin; this area was of high signal intensity on T2-weighted images. On repeat MRI performed 4 months after injury, T1-weighted images showed, in the same region, granular low signal intensity, while T2-weighted images showed high signal intensity. The MRI findings in the subacute and chronic stages of diffuse axonal injury are discussed.

Glycogen storage disease with normal acid maltase: skeletal and cardiac muscles

We report a 5-year-old boy with lysosomal glycogen storage disease and normal acid maltase activity. This patient, the fourth reported in the literature, was referred to our hospital for evaluation of elevated serum GOT, GPT, and CK activities. He had neither muscle weakness nor atrophy. Echocardiography demonstrated marked thickening of the intraventricular septum and left ventricular wall which indicated hypertrophic cardiomyopathy. Biopsied skeletal muscle disclosed massive accumulation of glycogen and autophagic vacuoles. Electron microscopy of biopsied cardiac muscle revealed severe myofibrillar disruption with marked accumulation of free and intralysosomal glycogen. Activities of all major glycolytic enzymes in skeletal muscle, including acid maltase, were normal. It is unknown why muscle lysosomes appeared to be unable to digest the trapped glycogen despite the presence of acid maltase. Our findings illustrate the importance of performing skeletal muscle investigation during childhood in patients with hypertrophic cardiomyopathy.

Influences on taste in the area of chorda tympani nerve after transtympanic injection of local anesthetic (4% lidocaine)

Transtympanic injection of 4% lidocaine (TTIL) is a unique procedure to treat tinnitus. Some physicians in Japan have been adopting this procedure to treat tinnitus. It has several complications, and safety standards of this procedure have not yet been established. Among the complications, we focused on "transient taste disturbance" after TTIL, because there have been no detailed reports on this subject. We examined the taste sensation in the area of the chorda tympani nerve before and after TTIL by applying electrogustometry with dB scale (EGM) and filter-paper disc method (FPD method). For a control, we used transtympanic injection of 0.4% dexamethasone (TTIS). After TTIL, transient pathway insufficiency on chorda tympani nerve was observed both in the EGM and the FPD methods, but this pathway insufficiency recovered within 24 h. Some patients felt spontaneous abnormal bitter taste sensation in the oral cavity after TTIL, but the reason for this phenomenon could not be determined.

Scanning electron microscopic study of the middle ear mucosa after transtympanic infusion of fluids with different osmotic pressure

This study focused on the morphological alteration of the mucous membrane of the middle ear after transtympanic infusion of fluids with different osmotic pressure. Our results suggested that fluids with high osmotic pressure will seriously damage the mucous membrane of the middle ear regardless of whether or not the fluids have ototoxicity. On the other hand, fluids with low osmotic pressure were found to demonstrate minor changes on the mucous membrane. The authors have confirmed through this study that Beriplast-P A (894 mOsm) and B (228 mOsm), fibrinogen-based tissue sealants, may be safely used in the middle ear with minimum injury to the mucous membrane.

The occurrence of acute lymphoblastic leukemia shortly after the cessation of human growth hormone therapy

We encountered a case of a 21-year-old man who had developed acute lymphoblastic leukemia (ALL) shortly after the cessation of approximately six years' human growth hormone treatment for pituitary dwarfism. The patient had also been treated with thyroid preparations and methylandrostanolone, a kind of anabolic steroid. Factors relating to the onset of ALL in this case are discussed.

Electron microscopic study of the biopsied cardiac muscle in Duchenne muscular dystrophy

Cardiac muscular biopsies were performed on 4 patients with Duchenne muscular dystrophy (DMD). None of the patients had cardiac symptoms and all of them exhibited normal electro- and echocardiographic findings. Electron microscopic examination of cardiac muscles from 4 patients with DMD disclosed proliferation of the mitochondria, changes in the cristae, abnormalities of the Z-bands, dilatation of the sarcoplasmic reticulum, deposition of glycogen, and changes in the nuclei. The most striking finding in these patients was that the residual bodies were increased and were observed mainly in the perinuclear region. These ultrastructural features suggest that an extreme exhaustion had already been present in myocardial tissue of the patients prior to the onset of cardiac symptoms.

Formation and propagation of brain oedema fluid around human brain metastases. A CT Study

Computerized tomography (CT) was used to examine the time-course of the propagation of extravasated contrast medium from small brain metastases into the peritumoural oedematous white matter, following infusion of 200 ml of meglumine amidtrizoate for 3 hours. Four patients with a metastatic brain tumour were examined. CT scans at identical levels were taken 1.5, 3, 6, 9, and 12 hours after start of contrast infusion. Following 4-7 days of dexamethasone treatment (8-12 mg/day i.v.) the examination was repeated. A contrast-enhanced area was observed surrounding the clearly delineated tumours, expanding gradually in a circular fashion into the peritumoural white matter oedema. The expanding circular enhancement was measured planimetrically on the various scans. From these values, the increase in radius/hr respectively in volume/hr was calculated, assuming a spherical geometry. This enabled a determination of the rate of oedema fluid formation and of the speed of oedema fluid propagation. The formation rate of oedema fluid amounted to 0.5-3.2 ml/hour and the speed of oedema fluid spreading to 1.9 mm/hour. Following treatment with dexamethasone the formation rate of oedema fluid is reduced by 30-50%. The important clinical implications of these new findings are discussed.

Changes in soft palate taste buds of rats due to aging and zinc deficiency--scanning electron microscopic observation

The effects of aging and zinc deficiencies on taste were studied. The soft palate of zinc-deficient old rats, prepared by feeding with a zinc-deficient diet, were studied by a light microscope and a scanning electron microscope, and comparative examination was made on the morphological changes in soft palate papillae and taste buds of young normal rats and control old rats. In the case of young normal rats, papillae similar to lingual fungiform papillae were observed on the soft palate; one taste bud per one papilla was observed. The papillae were concentrated in the central area of the soft palate continuing from the hard palate. In the case of old rats, decrease in the number of papillae, flattening of papillae, exfoliation and atrophy of mucosal epithelium and leveling of microplicae were observed. In the case of zinc-deficient old rats, the above-mentioned tendencies were more significant. While dense substance and microvilli were observed in taste pores of taste buds of young normal rats, these were found to decrease or disappear in the zinc-deficient old rats.

[Melanosis of choroid plexus papilloma of the lateral ventricle: a case report]

A case of pigmented, well differentiated, choroid plexus papilloma is reported. A 45-year-old man came to our hospital complaining of attacks of vertigo and nausea. Skull X-ray films and CT scan demonstrated a calcified tumor in the left middle fossa. Tumor removal was done, and it was found that the tumor occupied the inferior horn of the left lateral ventricle. Histological examination revealed well differentiated choroid plexus papilloma containing various shaped pigment granules in the cytoplasm. The pigment granules in the tumor cells were stained black by Fontana-Masson method for melanin. The stain was negative in a section subjected to oxidative bleach. Granules were PAS-positive and autofluorescence. Therefore, the pigment granules had properties of both melanin and lipofuscin. In the electron microscopic study the ultrastructural appearance of the pigment was similar to that of neuromelanin, but not to that of pre-melanosome of neural crest origin. The pigment in this case seemed to be formed by "melanization" of lipofuscin as Barden's theory of pseudo-peroxidation. There are several case reports of pigmented choroid plexus carcinoma. However, no case of pigmented, well differentiated choroid plexus papilloma has, so far, been reported.