Swallowing-induced paroxysmal supraventricular tachycardia

A 54-year-old man had palpitations on swallowing without any esophageal or heart disease. Electrophysiological findings, including an A wave in the high right atrial leads appearing prior to the A wave on His bundle electrogram, revealed that the arrhythmia was paroxysmal supraventricular tachycardia originating in an ectopic focus of the atrium with intraventricular aberration. Treatment with verapamil, 120 mg/day, reduced his symptoms in spite of an insignificant decrease in the arrhythmia observed with Holter dynamic electrocardiography.

Extraosseous osteogenic sarcoma arising from the retroperitoneum: a case report

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. Among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery.

[Plasma gastrin and secretin levels in patients with carcinoma of the esophagus before and after operation]

Twenty-two patients with esophageal cancer (8: preoperative, 8: one-month after surgery, and 6: more than 3 months after surgery) were orally loaded with 50 g of glucose, to determine the plasma gastrin levels. They were also loaded with oral 0.1N hydrochloride preoperatively and also one month after operation to examine the secretion kinetics of plasma secretin. In addition, the correlation between the G-cell (gastrin secretory cell) population in the pyloric region of the postoperative intrathoracic stomach and the plasma gastrin was investigated. The following results were obtained. Hypergastrinemia developed one month after surgery, but after 3 months or later, plasma gastrin levels almost returned to normal. Plasma secretin levels tended to decrease postoperatively; however, no statistically significant differences were observed. G-cell stain by the enzyme antibody method revealed hyperplasia of G-cells in some of the hypergastrinemic cases without accompanying atrophy of the pyloric mucosa and/or the intestinal epithelial metaplasia, although there were some hypergastrinemic cases with a decrease of G-cells due to the atrophy of the pyloric mucosa and/or the intestinal epithelial metaplasia. In the latter cases, gastrin was thought to be secreted probably from the duodenal mucosa.

Changes in plasma gastrin and secretin levels after pancreaticoduodenectomy

The kinetics of secretion of gastrin and secretin before and after pancreaticoduodenectomy were studied. Prior to pancreaticoduodenectomy, gastrin secretory function was within the normal range; it was significantly reduced postoperatively. Preoperatively, patients had elevated basal levels of secretin with depressed reactivity. During pancreaticoduodenectomy, the upper part of the jejunum should be preserved as far as possible. Ulcers occurring after pancreaticoduodenectomy are more probably due to vagus nerve activity and other factors rather than to an imbalance between gastrin and secretin.

Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Oral and intravenous glucose tolerance tests were performed in four groups: (1) preoperative patients, (2) patients with interposition reconstruction after total gastrectomy, (3) patients with Roux-Y reconstruction after total gastrectomy, and (4) patients with intrathoracic replacement after esophagectomy. We obtained the following results: (1) Hyperglucagonemia in response to orally administered glucose occurred after truncal vagotomy and occurred in the presence and absence of gastric tissue. (2) compared wtih the preoperative study, all postoperative groups demonstrated glucose intolerance. (3) The glucose intolerance was due to increased glucagon, insulinopenia, and possibly nutritional factors. (4) The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion. (5) The glucose tolerance curve shows that the interposition operation is superior the the Roux-Y operation.

Clinical manifestations of calcium oxalate monohydrate and dihydrate urolithiasis

We studied retrospectively 155 patients with calcium oxalate urolithiasis. The patients were divided into 3 groups: 1) those with calcium oxalate monohydrate, 2) those with calcium oxalate dihydrate and 3) those with mixed calcium oxalate monohydrate and dihydrate. Various differences were noted between patients with calcium oxalate monohydrate and those with calcium oxalate dihydrate, with respect to stone characteristics, spontaneous passage of stones, stone recurrence and multiple occurrence. Most important, we noted that patients with calcium oxalate dihydrate had more stone recurrences than patients with calcium oxalate monohydrate.

Urinary macromolecular substances as natural inhibitors of calcium oxalate crystal aggregation

We studied the inhibitory effect of urinary macromolecular substances (UMM), more than 10,000 mol. wt., on aggregation of calcium oxalate crystals in a crystal-seed system and a non-crystal-seed system. In both assay systems, UMM from non-stone-farmers showed a marked inhibitory activity on crystal aggregation, whereas UMM from recurrent stone-formers showed a weak inhibitory activity. The distinction between the two types of UMM was greater in the non-crystal-seed system. The macromolecular inhibitors seemed to be composed of proteins or protein-complexes inasmuch as approximately 70 to 90 per cent of the macromolecular inhibitory activity was destroyed by protein digestion with pronase. Urinary acid glycosaminoglycans, which have been considered possible inhibitors, played a small role in the inhibition of crystal aggregation.

[Effect of various kinds of glucocorticoids on experimental brain edema (author's transl)]

Although the effectiveness of glucocorticoids for the treatment of cerebral edema has been widely accepted in neurosurgical practice, but its mechanism is still obscure. Also the dose equivalent of various kinds of glucocorticoid preparation is still uncertain. Only the dose equivalent determined by the test examining an antiinflammatory effect on a growth of glanulation, has been applied for the treatment of brain edema. The authors attempted to establish the dose equivalent of each kinds of glucocorticoid for the treatment of cerebral edema. Cold induced cerebral edema was produced by touching a metal probe at the temperature of -90 degrees C for 3 minutes on the right parietal cortex of rat brain. Hydrocortisone (16 mg/kg), prednisolone (3.2 mg/kg), methylprednisolone (3.2 mg/kg), dexamethasone (0.8 mg/kg) and betamethasone (0.8 mg/kg) were administered at the time of 3 hours prior or after the cold injury. The animals were sacrificed 24 hours after injury and the grade of brain edema was determined by the changes of water content in the brain tissue. For this purpose, the authors developed a new method of measuring water content in the brain tissue using tritiated water and a liquid scintillation counter. In the group of animals which were treated with prednisolone, dexamethasone or betamethasone, the water content was significantly decreased compared to the value of non-treated animals. But in the animals treated with hydrocortisone or methylprednisolone, no significant changes of the water content was observed. But in the animals treated with double doses of hydrocortisone (32 mg/kg) or methylprednisolone (6.4 mg/kg), cerebral edema was improved significantly. From these results the authors concluded that the dose equivalent of each kinds of glucocorticoid for the treatment of the brain edema was as follows: hydrocortisone: prednisolone: methylprednisolone: dexamethasone: betamethasone = 40 : 4 : 8 : 1 : 1.

Intrarenal arteriovenous malformation

Our surgical experience with 7 cases of intrarenal vascular malformation is reported. Based on angiographic criteria the so-called congenital arteriovenous fistula of the kidney may be classified either as the cirsoid type, which represents a truly congenital form of arteriovenous malformation, or as the aneurysmal type, which is considered to be idiopathic or spontaneous. These 2 types of arteriovenous malformations are compared with regard to clinical presentation and the choice of surgical treatment for each type is discussed.

Experimental model of calcium-containing renal stone formation in a rabbit

An experimental method of calcium-containing renal stone formation was devised using a rabbit on normal diet. The stone formation was induced unilaterally, massively, and rapidly in an extremely high incidence by temporary obstruction of the upper urinary tract, but not by permanent obstruction. The contralateral kidney was used as a control. The initial stone formation was not solid but muddy and seemed to occur through massive crystal aggregation, resulting in concretion within a few weeks. We strongly suspect that the mechanism of this stone formation is crystal aggregation induced by temporary obstruction of the kidney. This animal model should contribute to the investigation of the process of crystal aggregation which is considered to be the most important factor in idiopathic calcium stone formation in man.

Transitional cell carcinoma arising from bladder left behind

A case of transitional cell carcinoma arising from a bladder which was left behind for more than 24 years without pyocystis syndrome is described. A search in the literature revealed 10 cases of defunctionalized bladder that developed tumors over a rather short latent period ranging from 3 months to 7 years, and mostly with evidence of severe bladder infection.

A new screening method for cystinuria. A simple and safe screening kit

The new kit (Urocystin) presented here utilizes the dark brown coloration which a neutral aqueous solution of cystine develops rapidly upon addition of nickel ion and sodium hydrosulfite (Na2S2O4). What is needed is pouring 4 ml of the urine sample into the kit, and the kit is able to judge without fail any urine sample with a cystine concentration of 50 microgram/ml or more as positive. No pretreatment of the sample is necessary. The kit contains no hazardous reagents at all. The kit has thus turned screening of cystinuria into an extremely simple affair.

[Evaluation of the role of brain scintigraphy in pineal tumors (author's transl)]

From January, 1969 to December, 1975, 1700 patients underwent sequential brain scintigraphy with Tc-99-m-pertechnetate. All the scintigrams were obtained on a scintillation camera with high-resolution collimator in our clinic. Intracranial tumors were confirmed in 449 cases and 21 cases out of those were pineal tumors which were diagnosed by clinical symptoms, air study, angiography and Conray-or Myodil-ventriculography. In these pineal tumors, 14 (67%) out of the 21 cases had positive scan on scintigrams. All of our cases of teratoma (one case) and teratocarcinoma (two cases) showed clear abnormal uptake, though it had been reported that they do not tend to have positive results on scintigrams. We also performed scintigraphy on 11 cases out of the 21, both before and after 60Co radiation therapy. In the cases which showed either same grade or more increased abnormal uptake on scintigrams after radiation therapy, compared with that before radiation therapy, compared with that before radiation, their prognoses were poor. On the other hand, those cases which showed decreased abnormal uptake after radiation, have had a healthy daily activities. From these experiences, it may be concluded that brain scintigraphy is clinically valuable not only for making the diagnosis, but for evaluating the effect of radiation therapy and the prognosis in the cases of pineal tumor.