Perfusion scan in pulmonary tumor microembolism: report of a case

A 76-year-old male patient was admitted to our hospital with the chief complaint of dyspnea. A chest CT scan showed pericardial effusion, mediastinal lymphadenopathy and a tumor in the right ventricle with invasion to the main trunk of the pulmonary artery. A 99mTc MAA perfusion lung scan revealed multiple small subsegmental peripheral defects and a "fissure sign", while the 133Xe ventilation scan was normal. After the chest CT scan and scans of both lungs, tumor microembolism was highly suspected. Open chest surgery was performed. A huge tumor in the right ventricle involving the main trunk of the pulmonary artery was found. In addition, multiple tumor thrombi in the pulmonary arteries and veins were also noted. The pathology was metastatic squamous cell carcinoma. Thereafter, the primary lesion was found by bronchoscopy. The final diagnosis was squamous cell carcinoma of the right lower lobe bronchus with metastases to the right ventricle and pulmonary vessels, and in association with pulmonary tumor microembolism. We present this uncommon case and describe the pulmonary perfusion pattern of the tumor microembolism.

The effect of the acetylcholine transport blocker vesamicol on central cholinergic pressor neurons

Vesamicol (AH5183) inhibits the uptake of acetylcholine into cholinergic neuronal storage vesicles. Earlier in vitro studies have demonstrated that such inhibition can lead to a failure of transmission, particularly in peripheral cholinergic tissues. The present study was designed to determine whether vesamicol could inhibit central cholinergic transmission in conscious freely moving rats. Central (lateral cerebroventricular) injection of 20 micrograms of vesamicol significantly reduced the hypertensive and bradycardic response to subsequent central injection of physostigmine in spontaneously hypertensive rats. Inhibition of the pressor response was greatest when physostigmine was administered 1 hr after vesamicol. Acetylcholine and choline levels were determined in three brain regions derived from rats treated one hr earlier with either vehicle or vesamicol. Acetylcholine levels were found to be unaltered after vesamicol treatment, although choline levels were significantly higher in two brain regions. These results are consistent with the ability of vesamicol to inhibit the function of central cholinergic cardiovascular regulatory neurons. The mechanism for this inhibition is not related to depletion of total brain acetylcholine content but may be due to depletion of a small critical pool of transmitter.

Electropharmacological effects of sandostatin in human atrial fibers

We studied the actions of sandostatin (0.1-1000 nM), an analogue of somatostatin, on human atrial tissues obtained from hearts of 20 patients undergoing corrective cardiac surgery. In 3 preparations showing fast response action potential in normal [K]0 Tyrode solution, sandostatin induced little effect, even at the highest concentration (1 microM). In 10 preparations showing a slow rate of phase-0 depolarization when atrial fibers were depolarized (maximum diastolic potential near -40 mV) in high [K]0 (27 mM), sandostatin at concentrations as low as 1 nM decreased significantly the velocity of the upstroke, and the amplitude of slow response of the action potential as well as the force of contraction. In 6 experiments on spontaneously active atrial fibers (maximum diastolic potential = -53.8 +/- 2.7 mV), sandostatin increased the spontaneous cycle length in a fashion dependent upon concentration. The decrease in spontaneous rate of firing was associated with an inhibition of the late diastolic slope, a change also induced by somatostatin. A longer period of washout, however, (30 min or longer) was required for complete recovery from the depressant effects. Sandostatin (0.1-100 nM) also depressed triggered activity induced by cardiotonic agents. The present findings indicate that sandostatin induces a prolonged action in human atrial cells. Sandostatin may depress abnormal automatic rhythms through an inhibition of transmembrane influx of calcium.

Unusual cardiac malformations in Holt-Oram syndrome: report of two cases

The Holt-Oram syndrome is a hereditary disease which associated with upper limbs anomalies and cardiac defects such as secundum type atrial septal defect. Two cases of this syndrome with unusual cardiac findings are reported: One has an unroofing coronary sinus type atrial septal defect and preexcitation syndrome, the other has pentalogy of Fallot.

Depressant effect of adenosine in isolated human and canine atrial fibres

STUDY OBJECTIVE0--he aim was to explore the cellular mechanisms responsible for the depressant effects of adenosine in human atrial tissues.

DESIGN

Conventional microelectrode technique was used to record transmembrane action potential of human atrial tissues obtained at cardiac surgery. Effects of adenosine (0.1-100 microM) on action potential characteristics and contractile force of human atrial fibres in the absence and presence of an adenosine receptor antagonist (DPSPX) were evaluated. Results were then compared with those obtained from the canine atrial tissues.

EXPERIMENTAL MATERIAL

Atrial tissues obtained from hearts of 25 patients undergoing corrective cardiac surgery were used. Seven mongrel dogs were anaesthetised and strands of atrial muscle were removed and used for comparison.

MEASUREMENTS AND MAIN RESULTS

In human atrial fibres showing fast response action potential (mean dV/dtmax around 100 V.s-1) in normal [K]o (4 mM) Tyrode solution, adenosine (1 nM-10 microM) did not induce consistent effects on the action potential characteristics. When the fibres were depolarised in high [K]o (27 mM) or in atrial fibres showing slow response action potential (dV/dtmax less than 50 V.s-1), however, 10 microM adenosine reduced the upstroke velocity and the amplitude of action potential significantly and markedly depressed the contractile force. In atrial fibres spontaneously active in normal Tyrode solution (maximum diastolic potential around -50 mV), adenosine inhibited rate of spontaneous discharge in a concentration dependent manner. Delayed afterdepolarisation and aftercontraction induced by adrenaline or/and high [Ca]o were also suppressed. The depressant effects of adenosine were blocked after pretreatment with 50 microM DPSPX, a specific antagonist for adenosine receptor.

CONCLUSIONS

These findings show that adenosine may abolish abnormal automatic rhythms and triggered activity in human atria.

[Gluco, lipometabolic and trace elements alteration in bile with acute purulent cholangitis]

Analysis was made of the gluco, lipometabolic materials and trace elements in bile from patients. The specimens were collected in 11 cases with acute purulent cholangitis and 13 cases of selective biliary surgery at both inter-operational time, at which the bile were got by needling from the common bile duct, and post-operational time, at which the bile was obtained from T tube drainage bile before the extraction of the T tube or discharge from hospital. It was found that lactic acid and glucose markedly decreased and LDH activity increased in the cholangitis group at inter-operational time. Lifted hepatic glyconeogenesis and gluco-consumption and hepatic cellular damage were indicated. At the same time, most of the lipo-materials and lipase activity increased, as compared with the selective group, which showed that lipolysis was encouraged and that lipo-materials had flowed into the bile because of hepatic cellular damage. At the time of acute cholangitis, the Zn and Fe in bile markedly increased but the Cr in bile decreased, and the mechanism was not clear.

[The role of hemorheologic changes in the pathogenesis of acute hemorrhagic necrotizing pancreatitis]

The hemorheologic alterations were studied in experimental acute hemorrhagic necrotizing pancreatitis (AHNP) which was induced by injection of 5% sodium taurocholate into the main pancreatic duct. The results showed that during the early stage of AHNP, all of hemorheologic parameters were significantly elevated, and continually increased at the rest intervals. The authors suggested that the blood viscosity and hematocrit increase, red blood cells tend to aggregate, and erythrocyte deformation decrease are the causation of pancreatic microcirculatory disturbances and promoting pancreatic progressive necrosis. After using low molecular dextran and Salvia miltiorrhizae, the hemorheologic alterations in AHNP were recovered, and the histologic observation improved. Our data indicate the hemorheologic disturbances is one of the key factors in the pathogenesis of AHNP.

Reconstruction of superior vena cava in invasive thymoma

Aggressive en-bloc resection of the superior vena cava was performed in a 50-year-old man who had superior vena caval syndrome caused by invasive thymoma. After the superior vena cava was resected, a Gore-Tex vascular graft was used to reconstruct the lower end of the right innominate vein and lower end of the superior vena cava. The patient was treated with postoperative radiotherapy to the mediastinum and has been asymptomatic for 14 months following surgery.

Electromechanical effects of protamine in isolated human atrial and canine ventricular tissues

Effects of protamine sulfate (1-100 mg%) on the electrical and mechanical activities of isolated dog ventricular tissues and human atrial fibers were studied. In dog Purkinje fibers, 10 mg% protamine reduced markedly the maximum diastolic potential and the rate of phase 0 depolarization. Eventually, slow response action potential developed at a depolarized level and the twitch force declined abruptly. The depolarization and the negative inotropy were reversed by increasing [Ca])o or [K]o but not by tetrodotoxin. When Purkinje fibers were depolarized in 27 mM [K]o Tyrode solution plus 0.5 microM epinephrine, higher concentrations of protamine (30 mg% or above) were required to depress the slow response action potentials and twitch, in contrast to the action of verapamil and diltiazem (1-30 microM). Dog ventricular and human atrial muscle fibers were more resistant to the depressant effects of protamine. In human atrial fibers, however, 10 mg% protamine was able to depress significantly the oscillatory afterpotentials and aftercontractions induced by epinephrine and theophylline. The present findings suggest that the depolarization and decline in force of cardiac tissues induced by protamine, at a concentration about twice of the maximum clinically relevant dose, may be explained by the development of slow response action potentials as a result of decrease in membrane K+ and Na+ conductances.

Depressant effects of isoflurane and halothane on isolated human atrial fibers

The present experiments were designed to study the cellular mechanism responsible for the depressant effects of halothane and isoflurane on human atrial tissues obtained at cardiac surgery. The fibers were superfused in Tyrode's solution, and transmembrane potentials were recorded with a microelectrode technique. In atrial fibers showing fast response action potential (maximum velocity of depolarization [Vmax] greater than 100 V/s), halothane (0.75 vol%, 0.44 mM) and isoflurane (1.25 vol%, 0.53 mM) decreased slightly the upstroke velocity but depressed the plateau and twitch force significantly. In atrial fibers showing slow rate of phase-0 depolarization or when atrial fibers were depolarized in high [K]0, both halothane and isoflurane decreased the upstroke of slow response and the force. The depressant effects of anesthetics partially mimicked the actions of 1 microM tetrodotoxin and diltiazem and could be reversed by epinephrine or high [Ca]0. The delayed afterdepolarizations or aftercontractions and contracture induced by epinephrine or strophanthidin were also inhibited by both anesthetics. Halothane and isoflurane may depress normal electromechanical activity and arrhythmogenic triggered activity through a reduction of cation fluxes across the cell membrane.

Controlled reperfusion following regional ischemia

The ability to reverse acute coronary occlusion with fibrinolytic agents and percutaneous transluminal angioplasty has increased interest in the revascularization of ischemic myocardium. This study defines changes in global ventricular function, mass, and compliance during acute coronary occlusion and following reperfusion with blood in the beating and arrested heart. In 17 dogs on cardiopulmonary bypass, the proximal left anterior descending coronary artery was occluded for 45 minutes. In 12 dogs, flow was reestablished by releasing the coronary snare in the beating heart. In the other 5 dogs, the snare was released during a continuous 10-minute infusion of blood potassium cardioplegia in the arrested heart. Coronary occlusion resulted in significant decreases in stroke work index and left ventricular (LV) mass, but compliance was unchanged. Reperfusion in the beating heart increased LV mass compared with the values measured before ischemia (104 +/- 5 versus 95 +/- 5 gm; p less than 0.05) and decreased LV compliance (39 +/- 4 versus 53 +/- 4 ml at LV end-diastolic pressure of 8 mm Hg; p less than 0.05). In contrast, with blood cardioplegia-based reperfusion in the arrested heart, LV mass and LV compliance remained unchanged from control values. We conclude that revascularization of acutely ischemic myocardium in the beating heart further impairs LV function by increasing LV mass and decreasing compliance. This damage can be avoided by reperfusion with blood cardioplegia in the arrested heart.

The effects on fetal brain development in the rat of a severely iodine deficient diet derived from an endemic area: observations on the first generation

Rats were fed on a severely iodine deficient diet (iodine content 4.5 micrograms/100 g) similar to that being consumed by people living in a village with a high rate of endemic cretinism. After a period of 4 months, the thyroid and brain were studied in the adult and their fetuses at 16, 17, 18, 19 and 20 days of gestation, and in postnatal animals at 1, 5, 10, 20, 30 and 60 days of age. By comparison with a control group (diet with iodine content 54.7 micrograms/100 g) the experimental group showed marked goitres, a higher uptake of 125I by the thyroid, reduced serum T4, and reduction in brain weight. The cerebral and cerebellar histological findings showed that the density of brain cells had increased, and the mean neuron size was reduced. Furthermore, disappearance of the cerebellar EGL was delayed. These findings indicate that this animal model is likely to be suitable for the studies of endemic cretinism in man.

A giant congenital aneurysm of the right coronary artery

A young woman with shortness of breath was diagnosed preoperatively as having a coronary artery aneurysm. The aneurysm originated from the right coronary artery and was extraordinarily large. The aneurysm was excised successfully under extracorporeal circulation.

A comparison of results of type I and type II radical operations for carcinoma of the gastric cardia

During 1954-1981, 527 patients with cancer of the gastric cardia underwent resection. Of these, 146 underwent type I radical operation (transthoracic resection) with eight (5.5%) operative deaths; 344 underwent type II radical operation (abdominothoracic resection) with 42(12.2%) operative deaths; and 37 with Stage IV lesions underwent extended operation or palliative operation with 4(10.8%) operative deaths. Of 440 cases of Stage I-III cases that survived the operation, the 5-year survival rate was 18.5%, and the 10-year survival rate was 10.7%. For stage I cancer, the end results of type I and type II radical operations were similar. In Stage II, whether the lymph nodes were positive or negative, the end result of the type II operation was better, but without statistical significance. In Stage III cancer without lymph node metastases, the end result of the type II operation was better, but without statistical significance; in those with lymph node metastases, the type II operation was definitely better than the type I operation (P less than 0.05).