[Case of simultaneous triple cancers of the duodenal papilla, gallbladder and stomach]

The patient was a 76-year-old man with simultaneous triple cancer arising in the duodenal papilla, gallbladder and stomach, whose complaint was epigastralgia. Endoscopic and radiologic studies revealed early gastric cancer (IIc) at the posterior wall of the antrum; ERCP disclosed obstruction with "apple core" appearance in the distal bile duct. Pancreaticoduodenectomy, cholecystectomy and distal gastrectomy with lymph node dissection were performed. Histopathological examination of the resected specimens revealed papillo-tubular adenocarcinoma in the duodenal papilla, well differetiated tubular adenocarcinoma in the gallbladder, and moderately differentiated tubular adenocarcinoma in the gastric mucosa.

Comparative evaluation of depressed automaticity in sick sinus syndrome by Holter monitoring and overdrive suppression test

To ascertain whether the long cardiac pauses on the Holter ECGs of patients with the sick sinus syndrome were related to the spontaneously occurring overdrive suppression, the heart rates for the 12 seconds preceding the cardiac pauses longer than 5 seconds were compared with that averaged for 24 hours. Even in six out of seven patients with bradycardia-tachycardia syndrome the former rate was not significantly greater than the latter, indicating that episodes of such long cardiac pauses may not result from spontaneously occurring overdrive suppression. This observation was also consistent with the result that no statistically significant correlation was obtained between the maximum pauses measured from Holter ECGs of sick sinus syndrome and those obtained by the overdrive suppression test. In conclusion, many episodes of long life-threatening cardiac pauses observed in sick sinus syndrome may be attributed to accidental depression of the sinus nodal and subsidiary pacemaker activity rather than to spontaneously occurring overdrive suppression; therefore, Holter monitoring may be useful as an additional tool for diagnosis of sick sinus syndrome.

Experimental studies on sick sinus syndrome: relationship of extent of right atrial lesions to subsidiary pacemaker shift and its function

An area where the sinus node was located in 36 dogs was defined as the "SN-area." Five to 7 days after cauterization of the SN-area, a subsidiary pacemaker remained in the SN-area in seven (group S) and shifted to outside the SN-area in 14 dogs (group E). The SN-area in group S had escaped complete destruction, but that in group E was destroyed completely. Heart rate in group S and group E was 154.0 +/- 27.1 and 107.6 +/- 16.8 beats/min (p less than 0.001), respectively. Maximum duration of asystole after overdrive (maxDAO) in group S and group E was 656.7 +/- 260.2 and 2470.2 +/- 2271.6 msec (p less than 0.01), respectively. Propranolol (0.2 mg/kg intravenously) decreased heart rate in group S and group E to 88.3 +/- 7.9 and 71.7 +/- 8.7% (p less than 0.001), and prolonged maxDAO to 140.1 +/- 28.1 and 492.7 +/- 591.4% (p less than 0.025), respectively. It is concluded that the rate and stability of subsidiary pacemakers after cauterization of the sinus node have a close relationship with their location in the right atrium, which is dependent on the extent of lesions in the SN-area. Sympathetic tone played a significant role in maintaining these functions in group E.

Cardiovascular effects of a newly synthesized cardiotonic agent (TA-064) on normal and diseased hearts

A new inotropic agent, TA-064, (-)-alpha-(3,4-dimethoxyphenethylaminomethyl)-4-hydroxybenzylalcohol, was shown to have strong effects in experimental animals. Its effectiveness and associated adverse effects were tested in humans invasively (n = 6) and noninvasively (n = 17). Increasing doses of intravenous infusion (1, 2, and 4 micrograms/kg/min) increased plasma levels to 15, 35, and 82 ng/ml, respectively, resulting in marked increases in the peak rate of left ventricular pressure rise (dP/dt) (1,450 +/- 63 to 3,042 +/- 349 mm Hg/s) (mean +/- standard error of the mean [SEM], p less than 0.01) and the ratio of dP/dt to left ventricular pressure at a developed pressure of 40 mm Hg (25 +/- 3 to 39 +/- 2 s-1) (p less than 0.01), with a reduction in left ventricular end-diastolic pressure (12 +/- 2 to 4 +/- 1 mm Hg) (p less than 0.01). Minimal or no changes were seen in heart rate and left ventricular systolic pressure. After a single oral dose (10 mg), the plasma level reached its peak at 90 minutes (16 +/- 9 ng/ml, n = 17). A positive inotropic effect was confirmed echocardiographically in both healthy volunteers (n = 8) and patients with congestive heart failure (CHF) (n = 9) who were maximally treated with conventional regimens: increase in mean velocity of circumferential fiber shortening (healthy volunteers: 1.29 +/- 0.05 to 1.60 +/- 0.11 circ/s [p less than 0.05]; patients with CHF: 0.69 +/- 0.08 to 0.93 +/- 0.09 circ/s [p less than 0.01]), ejection fraction (healthy volunteers: 68 +/- 2 to 75 +/- 2% [p less than 0.05], patients with CHF: 37 +/- 4 to 45 +/- 5% [p less than 0.01]) without change in heart rate. The cardiac index was increased only in the CHF group (2.71 +/- 0.22 to 3.21 +/- 0.24 liters/min/m2) (p less than 0.05). No significant untoward effects were observed. Thus TA-064 is a potent inotropic agent and can be used either parenterally or orally. Salutary effects can be expected in patients with congestive heart failure who are treated with digitalis and diuretic agents.

[Clinical experience in patients with Pancoast's tumor treated by fast neutron therapy]

We review our results with fast neutron therapy in Pancoast's tumor, and compare them with results obtained by photon beam therapy. 13 patients with Pancoast's tumor were divided into two groups; Group I (8 patients) received fast neutron therapy. Group II (5 patients) were treated by voltage X-ray therapy. 1. Group I was comprised of 3 patients receiving mixed beam therapy (TDF 80-100) and 5 patients subjected to boost therapy. All group II patients received 3100 to 8000 rads. 2. Fast neutron therapy was effective in 7 patients. In group II, high voltage X-ray therapy was effective in only 3 patients. 3. Two group I patients are still alive without signs of recurrence. The others died with a mean survival of 11 months. All group II patients died; their mean survival was 4.2 months. Our results suggest that fast neutron therapy is suitable and effective in patients with Pancoast's tumor.

Neutral glycosphingolipids and gangliosides of bovine thyroid

By the application of a ganglioside-mapping technique, the lipid composition of bovine thyroid was analyzed systematically. The contents of cholesterol, lipid-bound phosphorus and lipid-bound sialic acid in bovine thyroid were 5.10, 9.76, and 0.28 mumol/g of dry tissue, respectively, and the molar ratio of cholesterol, lipid-bound sialic acid, and lipid-bound phosphorus was 52.4 : 2.9 : 100.0. The following phospholipids were contained in this order: phosphatidylcholine greater than phosphatidylethanolamine greater than sphingomyelin greater than phosphatidylserine and phosphatidylinositol greater than cardiolipin. When compared on a molar basis, the amount of total glycosphingolipids was only 3% of phospholipids. As the major neutral glycosphingolipids, ceramide glucoside, ceramide galactoside, ceramide lactoside, ceramide trihexoside and globoside were identified and the most abundant component was globoside (40% of total neutral glycosphingolipids). On the other hand, five molecular species of gangliosides were identified: GM3, GM1, fucosyl GM1, GD3, and GD1a. Three types of GD3 and GD1a with a different sialic acid composition were recognized on the ganglioside-map and isolated in pure forms. GM3 was the most abundant component, but the concentration of gangliosides with ganglio-N-tetraose in bovine thyroid was higher than that of gangliosides with lactose. Also fucosyl GM1 comprised 13% of total gangliosides. Thus, the high concentrations of gangliosides with ganglio-N-tetraose and fucosyl GM1 seemed to be characteristic of bovine thyroid glycosphingolipids. The glycosphingolipids contained in the following order: GM3 greater than GD1a greater than globoside greater than GM1 greater than ceramide trihexoside greater than fucosyl GM1 greater than ceramide lactoside greater than ceramide glycoside greater than GD3 greater than ceramide galactoside.

Formation of Scales of Calcium Carbonate Polymorphs: The Influence of Magnesium Ion and Inhibitors

Summary

The crystallization of calcium carbonate on calcite and aragonite at 70 deg. C has been investigated by use of a highly reproducible seeded growth technique. In both cases the rates of reaction are proportional to the square of the relative supersaturations and are surface controlled. The presence of low levels of magnesium ion inhibits calcite growth with the formation of magnesian calcite, while at higher concentrations the spontaneous precipitation of aragonite takes place. Hydroxyethylidene 1,1 diphosphonic acid (HEDP), a potential scale inhibitor, markedly reduces the growth rate of both calcite and aragonite but has little effect on the crystallization of vaterite, the least thermodynamically stable calcium carbonate polymorph. The exclusive growth of vaterite on vaterite seed at 70 deg. C under these conditions strikingly demonstrates the possibility of the formation of intermediate metastable precursors during scale formation.

Introduction

The precipitation and dissolution of calcium carbonate is important in a wide variety of fields. Most subsurface waters produced with oil and gas contain relatively high concentrations of calcium ions. Moreover, since the concentration of CO2 in these water, is usually considerably greater than that at the surface, calcium carbonate is one of the more important scale-forming minerals in oil and gas production. In thermal flood operations, the reinjection of waste water into subsurface formations frequently introduces the problem of calcium carbonate scale formation. Although this often can be controlled by lowering the pH of the solution contacting the surfaces, the problem is made more acute by a decreasing solubility with increasing temperature and because the salt can crystallize from aqueous solution in at least three forms - calcite, aragonite, and vaterite. Although calcite has the greatest thermodynamic stability at ambient conditions, the thermodynamically less stable aragonite and/or vaterite phases may be stabilized under certain conditions of temperature or in the presence of other ions. Many surface waters contain appreciable quantities of magnesium ion, and its influence on the mineralogy and morphology of calcium carbonate has been investigated intensively. Thus, it is well established that the magnesium ion favors the precipitation of aragonite rather than calcite. In addition, this additive markedly inhibits the nucleation and crystal growth of calcite and sometimes induces formation of needle-like magnesian calcites, MgCal. In contrast, the crystal growth of aragonite is scarcely affected by the presence of magnesium ion. The inhibition of calcite growth by magnesium ion has been attributed to various factors. Reversible adsorption at active growth sites on the calcite crystals may prevent crystallization; the magnesium ion therefore behaves as a simple surface poison, allowing the aragonite, which precipitates more rapidly, to be stabilized kinetically. Another view is that the incorporation of magnesium ion into the growing crystalline phase during the formation of magnesian calcite introduces strain into the lattice with concomitant increase in solubility of the solid phase. The resulting decrease in the degree of super-saturation therefore leads to an apparent retardation of calcite growth caused by the decrease in driving force. The incorporation of magnesium ion having a smaller ionic radius compared with the calcium ion produces appreciable lattice strain on the surface of the calcite, inhibiting further crystal growth. This model also accounts for the observed formation of needle-like crystals during the growth of calcite in the presence of magnesium by preferentially poisoning crystal growth perpendicular to the c axis.

JPT

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