Lymph nodes in the hepatoduodenal ligament: US appearances with CT and MR correlation

OBJECTIVE

To examine the ultrasound (US) appearances of the lymph nodes in the hepatoduodenal ligament in patients with and without hepatic diseases.

PATIENTS AND METHODS

US appearances of elliptical nodules around the common hepatic artery and/or the portal vein were prospectively examined in 156 sequential patients referred for US scans. Retrospective review of CT (n=5) and MR (N=9) appearance of this structure was also performed.

RESULTS

Hepatoduodenal lymph nodes were seen by US in 48 of 157 patients (31%). They were visualized in 25 of 103 patients without liver disease (24%) and 12 of 17 patients with viral hepatitis and/or cirrhosis (71%). Patients with viral hepatitis and/or cirrhosis had significantly larger hepatoduodenal nodes than patients without these diseases (P<0.01). An echogenic focus or line representing the lymphatic hilus was noted in 28 patients. The lymph nodes were hyperintense relative to the liver on T2-weighted MR images.

CONCLUSION

US visualization of the lymph nodes in the hepatoduodenal ligament is not uncommon even in patients without known liver disease. Enlargement of these nodes is frequently seen in patients with viral hepatitis and/or cirrhosis.

[Intrapleural bleomycin for management of malignant pleural effusions]

We studied the efficacy of intrapleural administration of bleomycin for the management of malignant pleural effusions of non-small cell lung cancer in 24 cases. Bleomycin 60 mg was administered into the pleural space after tube drainage. If the effusion continued, one additional dose was given. The efficacy was seen in 18 cases (75%). The main adverse drug reaction was transient fever among others. There was little toxicity and no cases of pulmonary fibrosis. Intrapleural administration of bleomycin is useful in management of malignant pleural effusions.

Effect of a novel anti-rheumatic drug, TA-383, on type II collagen-induced arthritis

The effects of Ta-383 (0.016, 0.08, 0.4, 2 and 10 mg/kg) and anti-rheumatic drugs (lobenzarit 10 and 50 mg/kg, dexamethasone 0.25 mg/kg) were evaluated on type II collagen-induced arthritis in DBA/1J mice. The arthritis score was markedly suppressed in the groups treated with dexamethasone and TA-383. Serum anti-type II collagen IgG was significantly suppressed in the groups treated with dexamethasone and 0.4 mg/kg TA-383. Histopathological evaluation of the knee joints revealed suppression of the inflammatory changes in the groups treated with dexamethasone and TA-383. These findings suggest that the histopathological examination of the joints of the animal model is useful for the evaluation of anti-rheumatic drugs, and that TA-383 has suppressive effects on type II collagen-induced arthritis, an animal model for human rheumatoid arthritis.

Facial nerve paralysis induced by herpes simplex virus in mice: an animal model of acute and transient facial paralysis

We have been the first to succeed in producing an acute and transient facial paralysis simulating Bell's palsy, by inoculating herpes simplex virus into the auricles or tongues of mice. The KOS strain of the virus was injected into the auricle of 104 mice and the anterior two thirds of the tongue in 30 mice. Facial paralysis developed between 6 and 9 days after virus inoculation, continued for 3 to 7 days, and then recovered spontaneously. The animals were painlessly sacrificed between 6 and 20 days after inoculation for histopathologic and immunocytochemical study. Histopathologically, severe nerve swelling, inflammatory cell infiltration, and vacuolar degeneration were manifested in the affected facial nerve and nuclei. Herpes simplex virus antigens were also detected in the facial nerve, geniculate ganglion, and facial nerve nucleus. The pathophysiologic mechanisms of the facial paralysis are discussed in light of the histopathologic findings, in association with the causation of Bell's palsy.

Pattern generation method by direct toner irradiation

A novel method for toner pattern generation is proposed. The image pattern is simply formed by direction of a light flash through a pattern mask to expose toner on a transparent support. The force of movement from light of which the optical energy density was 0.73 J/cm(2) and the exposure time was 0.43 ms FWHM was estimated to be more than 2.8 x 10(-9) N. The cause of the transfer was examined, and ablation of toner was determined to be the most likely. If this method can be applied to a printer, a simple process to form images may be realized.

Clinical significance of reverse redistribution phenomenon after coronary artery bypass grafting

The reverse redistribution (RR) phenomenon is a decrease in thallium 201 uptake during redistribution compared with 201Tl uptake immediately after exercise. We evaluated RR in 23 patients after coronary artery bypass grafting. Postoperative RR was present in 48% and was significantly more common in patients with a history of myocardial infarction (62%). The patients were classified according to the presence (+) or absence (-) of RR. An analysis of left ventricular wall motion showed significant improvement after coronary artery bypass grafting in the RR+ group (n = 12) but not in the RR- group (n = 11). Quantitative myocardial viability was evaluated using the defect volume ratio, mean defect severity, and defect severity index. The preoperative defect volume ratio was higher in the RR+ group than in the RR- group (p < 0.05). In the RR- group, no improvement in these indices was observed after operation. In contrast, the RR+ group showed significant improvement in all three indices (p < 0.05). These results indicate that after coronary artery bypass grafting, an adequate blood supply to the remaining myocardium may induce RR. This phenomenon, therefore, may be a significant indicator of postoperative myocardial viability.

Taxonomic position of deep-seated, mucosa-associated, and superficial isolates of Trichosporon cutaneum from trichosporonosis patients

Clinical isolates of Trichosporon cutaneum, the causative agent of trichosporonosis, were identified on the basis of DNA relatedness. Of the 10 strains from deep-seated and mucosa-associated infections, 9 were identified as T. asahii and 1 was identified as T. ovoides. The two superficial strains were identified as T. cutaneum and a variety of T. montevideense. These findings suggest that T. cutaneum is a heterogeneous species in clinical samples and that the causative agents of trichosporonosis exist in four or more species.

Proximal tibiofibular joint: a radiographic and computed tomographic study

In 671 knees of 351 patients, the proximal tibiofibular joint was radiologically investigated. To clearly detect the contour of the joint, radiographs were obtained under fluoroscopic control with the lower extremity internally rotated. The contour was classified into three types: the joint lines of both tibia and fibula are straight (A); the joint line of the fibula is convex (B); the joint line of the tibia is convex (C). The rotation and the inclination of the joint were measured. Of the 671 knees, CT examination was also carried out in 51 knees. The obliquity of the joint was measured and the location of the fibula as related to the tibia was evaluated by CT. We also examined the relationships between the contour and the rotation, inclination, obliquity of the joint and the location of the fibula, and determined the characteristics of type B and C as compared with type A. The characteristics of type B were as follows: (1) this type was mainly seen in younger patients, (2) the rotation was the lowest and the inclination was the highest among the three types, (3) in CT the joint line was more saggital and the fibula was located more anteriorly. The characteristics of type C were as follows: (1) this type was seen in older patients, (2) the rotation was the highest and the inclination was the lowest among the three types, (3) in CT the joint line was more frontal and the fibula was located more posteriorly.

Surgical repair of a ventricular septal defect in a patient with trisomy 8 syndrome

We surgically repaired a ventricular septal defect (-VSD) in a patient with trisomy 8 syndrome. This case illustrated a number of characteristic clinical features associated with trisomy 8 syndrome patients which have previously been reported in the literature. However, our patient's VSD was not found to be particularly different from the VSD of patients without chromosomal abnormalities during either the surgery or the postoperative course.

Concurrent radiotherapy and chemotherapy with protracted continuous infusion of 5-fluorouracil in inoperable esophageal squamous cell carcinoma

PURPOSE

The feasibility of a concurrent chemoradiotherapeutic protocol for patients with inoperable esophageal squamous cell carcinoma was tested.

METHODS AND MATERIALS

Concurrent chemoradiotherapy using protracted low-dose continuous infusions of five-fluorouracil (5-FU; 250-300 mg/m2/24 h) and standard external beam irradiation was given to 28 patients with inoperable esophageal squamous cell carcinoma between November 1991 and June 1993.

RESULTS

For 25 patients receiving a total dose of > or = 60 Gy and concurrent 5-FU infusion for more than 5 weeks, the complete response rate was 52%. Local progression-free rate in this chemoradiotherapy group was significantly higher than the historical controls treated by radiotherapy alone (p < 0.05). A multivariate analysis revealed the treatment scheme (concomitant chemoradiotherapy vs. radiotherapy alone) to be a significant factor in local control (p < 0.01). Swallowing pain (39%), anorexia (39%), and nausea (32%) were the most frequent early reactions. Serious late radiation complications have not been observed.

CONCLUSION

The concurrent chemoradiotherapy using protracted low-dose continuous infusion of 5-FU and standard radiotherapy is an effective and safe method to obtain a local control in inoperable esophageal squamous cell carcinoma.

[Histomorphometric study of osteoporosis in rheumatoid arthritis]

A histomorphometric study of osteoporosis in rheumatoid arthritis was performed on thirty-eight specimens from the proximal tibial metaphysis, which were obtained during total knee arthroplasty. Fourteen specimens from the proximal tibial metaphysis of osteoarthritis patients were also histomorphometrically studied, and the osteoporosis in rheumatoid arthritis was compared with it in osteoarthritis. In nine rheumatoid arthritis patients, specimens from the iliac bone were obtained, and the difference between the generalized osteoporosis and the juxta-articular osteoporosis was evaluated. The proximal tibial metaphysis in rheumatoid arthritis was usually represented by a fairly low bone area and by thin mean trabecular thickness. No correlations were seen between histomorphometric parameters and the age at operation, the age of onset and the duration of disease. However, in patients of long duration (over 20 years), the bone area was very low and mean trabecular thickness was thin. In one parameter (scalloped surface) which shows bone resorption, there was a high correlation between generalized osteoporosis and juxta-articular osteoporosis in rheumatoid arthritis. There was no significant difference between rheumatoid arthritis and osteoarthritis in bone area and mean trabecular thickness. However, the scalloped surface of rheumatoid arthritis was significantly higher than it of osteoarthritis.

Dopamine D3 receptor gene polymorphism and the psychiatric symptoms seen in first-break schizophrenic patients

To investigate the possible effect of polymorphism at the BalI site of the dopamine D3 receptor gene (DRD3) on the phenotype in human subjects, allele and genotype frequencies for this polymorphic site were examined in 113 schizophrenic patients, including six subgroups, and 48 normal controls. The schizophrenic subgroups included patients with early onset, those with a family history, and those who suffered from one of the following psychiatric symptoms at their first episode: (1) delusion and hallucination; (2) disorganization; (3) bizarre behavior; and (4) negative symptoms. No significant differences were observed in genotype, allele and homozygosity frequencies between the whole group or any subgroup of schizophrenic patients and the controls. The present results indicate that polymorphism at the BalI site of the DRD3 is unlikely to be a major contributor to any of the psychiatric parameters examined in the present population of schizophrenic subjects.

[Clinical and serological studies in six cases of chlamydial pneumonia]

Clinical and serological studies of chlamydial pneumonia were done in six patients (three men and three women). The other three patients had no avian contact and showed almost the same clinical symptom. Acute infection with Chlamydia psittaci and Chlamydia pneumoniae were diagnosed in two patients and in one patient, respectively, by MFA. Because in some cases Chlamydia psittaci pneumonia and Chlamydia pneumoniae pneumonia are difficult to differentiate, it is necessary to use a test that allows different chlamydia species to be distinguished.

[Phase II study of a continuous five-day intravenous infusion of cisplatin and etoposide with concurrent chest radiation therapy in limited stage small cell lung cancer]

The efficacy of continuous five-day intravenous infusion of cisplatin (CDDP) and etoposide with concurrent chest radiation therapy was evaluated in patients with limited stage small cell lung cancer. The first group of patients registered from February 1989 to September 1990 received three courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 40 mg/m2/day x 5 days) and concurrent chest radiation therapy on the third course with dose reduction of etoposide. The second group of patients registered after February 1991 received four courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 50 mg/m2/day x 5 days) and concurrent chest radiation therapy on the first and second courses with dose reduction of etoposide. The response rates were 91.7% and 93.3%, respectively. The median duration of survival was 32.0 months and 20.1 months, respectively. Major toxicity was leukocytopenia and 64% and 80% of patients encountered leukocytopenia of Grade 3 or 4. In conclusion, these regimens show remarkable efficacy with acceptable toxicity.

A clinical study on the effects of pulsatile cardiopulmonary bypass on the blood endotoxin levels

Levels of endogenous endotoxins have been reported to increase after cardiopulmonary bypass. Endotoxin levels have also been implicated in multiple organ failure and may contribute to the immunocompromised state seen after bypass. We evaluated the effects of pulsatile cardiopulmonary bypass circulation on endogenous endotoxin levels. The study population consisted of 15 consecutive adult patients who underwent cardiac operations with cardiopulmonary bypass. Pulsatile flow was used during aortic crossclamping in eight patients (group I) and nonpulsatile flow was used in the remaining seven patients (group II). Changes in blood endotoxin levels were monitored during aortic crossclamping, after release of the clamp, and after weaning from bypass. The blood endotoxin level at each stage was expressed as a percentage of the level at the beginning of bypass. Group I patients a significantly lower blood endotoxin percentage than group II (from 20 to 120 minutes after the initiation of aortic crossclamping). In group I, the blood endotoxin percentage was nearly constant during aortic crossclamping. After release of aortic crossclamping, group I also had a lower blood endotoxin percentage than group II. Endogenous endotoxin levels appear to increase in the presence of intestinal congestion and ischemia. Improvement in intestinal circulation by pulsatile cardiopulmonary bypass may prevent increases in endogenous endotoxin levels by reducing these factors.

Optimal perfusion pressure for experimental retrograde cerebral perfusion

We evaluated cerebral metabolism during retrograde cerebral perfusion (RCP) and circulatory arrest during profound hypothermia, and also investigated the effects of perfusion pressure on RCP. Twenty-four adult mongrel dogs were placed on cardiopulmonary bypass and cooled to a nasopharyngeal temperature of 20 degrees C. At this temperature, hypothermic circulatory arrest (HCA; n = 6), and RCP with a perfusion pressure of 10 mmHg (RCP10; n = 6), 20 mmHg (RCP20; n = 6), and 30 mmHg (RCP30; n = 6) were carried out for 60 minutes. RCP was performed with oxygenated blood via the bilateral maxillary veins, and the retrograde flow rate was regulated to maintain a mean perfusion pressure of 10, 20, or 30 mmHg in the external jugular vein. At 60 minutes of RCP, we measured nasopharyngeal temperature; regional cerebral blood flow (rCBF); cerebral oxygen consumption, carbon dioxide excretion, and excess lactate; cerebral tissue adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP) and energy charge; and cerebral tissue water content. In the RCP10 group, there was excess cerebral lactate, and ATP and energy charge were low. In the RCP30 group, the water content of cerebral tissue was significantly higher than in other groups. In the RCP20 group, temperature was maintained in a narrow range, oxygen consumption and carbon dioxide excretion could be observed, there was no excess lactate, and ATP and energy charge were significantly higher than in the HCA group. In conclusion, RCP can provide adequate metabolic support for the brain during circulatory arrest, and a perfusion pressure of 20 mmHg is most appropriate for RCP.

[Surgery of bilateral pulmonary aspergilloma]

A 60-year-old man with cough and fever was admitted to our hospital. Chest radiography revealed multiple bullae and fungus balls in both lungs. He was treated with MCZ and FCZ for about 2 months, but the chest radiograph shadows did not improve and the fever continued. A two-stage operation was performed. The bullae were incised and the fungus balls were removed, then a muscle flap plombage was made with a pectoralis major muscle, a latissimus dorsi muscle and an intercostal muscle. The postoperative course was uneventful and respiratory function was preserved.

[Experimental study of optimal perfusion pressure during retrograde cerebral perfusion]

The effects of retrograde perfusion pressure on the brain was experimentally investigated during profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Retrograde cerebral perfusion (RCP) with perfusion pressure of 10 mmHg (RCP10; n = 5), 20 mmHg (RCP20; n = 5), 30 mmHg (RCP30; n = 5) underwent for 60 minutes. The oxygenated blood was infused via the bilateral maxillary veins, and the flow rate was kept to maintain a desired pressure in the external jugular vein for each group. Regional cerebral blood flow (rCBF), excess lactate, cerebrospinal fluid pressure (CSFP), adenosine triphosphate (ATP) concentration of cerebral tissue, and water content of cerebral tissue were measured. In the RCP10 group, cerebral excess lactate was positive and ATP concentration was low. In the RCP30 group, the water content of cerebral tissue was significantly higher than those in the other groups. In the RCP20 group, the excess lactate was maintained in a negative range, and ATP concentration was significantly higher than in the RCP10 group. In conclusion, RCP may provide metabolically adequate support for the brain and a perfusion pressure of 20 mmHg was appropriate for RCP in dogs.

The effect of pulsatile perfusion on cerebral blood flow during profound hypothermia with total circulatory arrest

In 39 mongrel dogs, regional cerebral blood flow was measured during pulsatile and nonpulsatile deep hypothermic cardiopulmonary bypass with total circulatory arrest. Total circulatory arrest was performed at 20 degrees C cerebral temperature for 40 minutes in 15 dogs, 60 minutes in 12 dogs, and 80 minutes in 12 dogs. Cerebral blood flow in both groups decreased as cerebral temperature fell and there was no significant difference in cerebral blood flow between the two groups during the cooling period. After circulatory arrest for 40 minutes, as cerebral temperature increased to 35 degrees C, cerebral blood flow in both groups recovered to values as high as the respective initial values, which were measured just after the beginning of cardiopulmonary bypass for cooling (102.5% +/- 10.2% in the pulsatile group and 97.2% +/- 12.6% in the nonpulsatile group). After circulatory arrest for 60 minutes, cerebral blood flow in the pulsatile group increased to 141.8% +/- 16.1% of its initial value when the cerebral temperature became 35 degrees C, but it remained significantly lower (64.5% +/- 9.2%) in the nonpulsatile group (p < 0.01). After circulatory arrest for 80 minutes, cerebral blood flow in both groups remained lower than the respective initial values. These results suggest that pulsatile perfusion maintains cerebral blood flow even during profound hypothermia and that it may protect the brain from ischemic and hypoxic damage caused by profound hypothermia and total circulatory arrest in cardiac operations.

Urinary carnitine excretion in patients with heart failure

To evaluate the fatty acid metabolism in heart failure, the semiquantitative analysis of urinary free carnitine and acylcarnitine was made by fast atom bombardment mass spectrometry (FABMS) in 22 patients (mean age 67.3 years) with heart failure and 19 age-matched healthy controls (average age 60.4 years). Urinary excretion of free carnitine was 0.20 +/- 0.118 ratio/mg creatinine in the healthy controls and 1.32 +/- 1.170 ratio/mg creatinine in the patients with heart failure. The latter value was significantly higher (p < 0.01). Patients with heart failure were classified into two groups according to the urinary free carnitine concentration. One was the high excretion group (2.19 +/- 0.102 ratio/mg creatinine, 12 cases) and the other was the low excretion group (0.37 +/- 0.212 ratio/mg creatinine, 10 cases). In the high excretion group, urinary acetylcarnitine was also increased, but no significant abnormalities were observed in the urinary organic acid profile. In the high group, 1 patient was classified as NYHA class III and 11 as NYHA class IV. Four patients died in the hospital. In the low excretion group, five patients were classified as NYHA class III and five as NYHA class IV. Only one patient died in the hospital. In the high group, patients with severe and prolonged heart failure tended to maintain higher values of urinary free carnitine. We could not find any abnormalities in fatty acid metabolism in patients with heart failure, but it is suspected that the patients who excrete large amounts of free carnitine into the urine, namely the patients with severe heart failure, have some possibility of carnitine deficiency.

[Transcatheter embolization of aorto-pulmonary collateral arteries in cyanotic congenital heart disease]

Transcatheter embolization (TE) using steel coils was performed on three patients with aorto-pulmonary collateral arteries (APCAs). Case #1: In a 13-year-old boy who had undergone corrective surgery for pulmonary atresia with ventricular septal defect (PA with VSD), one APCA was embolized by the TE technique. This resulted in a remarkable improvement in postoperative pulmonary congestion. Case #2: A 13-year-old boy who had previously undergone procedures to correct tetralogy of Fallot (TOF), underwent TE for two APCAs prior to subsequent surgery before for pulmonary stenosis. The procedure abandoned one APCA because of the long narrow origin of the vessel. For the other APCA, TE was unsuccessfully performed due to the displacement of a coil into the peripheral pulmonary artery. Case #3: An 8-year-old girl with PA with VSD underwent TE for three APCAs before corrective surgery. One APCA arising from the abdominal aorta was occluded successfully. The other two were considered too small at the orifice for TE, and were ligated surgically before corrective surgery. TE is a safe and effective method for suitable cases of APCAs. However, caution should be exercised to prevent complications. The selection of appropriate coils and catheters is also important.

Bilateral main bronchial compression caused by the ductal ligament

Several authors have reported cases of respiratory distress resulting from bronchial compression due to a hypertensive pulmonary artery in the setting of a large left-to-right shunt. However, respiratory distress due to bilateral main bronchial compression due to an enlarged pulmonary artery suspended posteriorly by the ductal ligament following repair of a ventricular septal defect is extremely rare. In this report, we advocate the necessity of dividing the ductal ligament in some patients with large left-to-right shunts when there are episodes of idiopathic respiratory distress before operation.

Disruption of the expanded polytetrafluoroethylene (EPTFE) graft of axillofemoral by-pass

The rupture of the artificial vascular graft is a rare complication. The disruption of the expanded polytetrafluoroethylene (EPTFE) graft has never been reported. The present report describes a patient who suffered the disruption of an EPTFE graft five years after a right axillofemoral by-pass.

Pericardial cyst in the midline position

Pericardial cysts are uncommon benign abnormalities and their incidence in mediastinal tumours is approximately 7%. The authors report the case of a 73-year-old man suffering from pericardial cyst in the midline position. The good results obtained following surgery are also reported.

[Experimental studies of pulsatile retrograde cerebral perfusion]

This study was investigated for the effects of pulsatile flow on retrograde cerebral perfusion under profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Five dogs were performed non-pulsatile retrograde cerebral perfusion (NP-RCP) and 5 were pulsatile retrograde cerebral perfusion (P-RCP) for 60 minutes each group. The rest of 5 dogs were performed hypothermic circulatory arrest (HCA) without any circulatory assist. Retrograde cerebral perfusion flow rate was regulated to maintain an external jugular vein pressure of 20 mmHg by infusing oxygenated blood by way of bilateral maxillary vein. Regional cerebral blood flow (rCBF), cerebrospinal fluid pressure (CSFP), adenosine triphosphate (ATP) concentration of cerebral tissue, and water content of cerebral tissue were measured. The rCBF were no statistical difference between the two groups. CSFP and ATP concentration in both of NP-RCP and P-RCP were significantly higher than those of HCA. Water content of cerebral tissue in P-RCP were significantly lower than those of NP-RCP. We concluded that retrograde cerebral perfusion for 60 minutes protects the brain as the assistances of circulatory arrest and retrograde cerebral perfusion with pulsatile flow has the possibility to control brain edema as compared with non-pulsatile flow in dogs.

[Thirty seven cases of respiratory syncytial virus infection hospitalised and 7 severe cases with apneic attacks]

We studied 37 cases of respiratory syncytial virus infection hospitalized during the period January 1, 1989 and March 31, 1993. 37 patients were 0-4 years old on admission. Fever, positive CRP and elevation of BSG were frequent in patients aged 8 months-4 years old. Patient more than 8 months of age didn't need supplementation of oxygen. Of the 37 patients, we had one case who had hyponatremia and six cases who were admitted with severe apneic attacks required incubation. Of the six cases, one patient had delayed neurological deterioration after anoxia due to apneic attacks. He, followed up for 4 years, have serious residual deficits including spastic quadriplegia, delayed development and epilepsy. Variety of factors, including premature birth, young postnatal age and milk feeding appeared to be significant risk factors for sever infections of RSV. In RSV infection, apneic attacks can cause near-miss SIDS. So, we stress the importance of careful and rapid diagnosis for all infants less than 8 months of age.

Surgical treatment of the Wolff-Parkinson-White syndrome in children

From 1986 to 1989, seven children ranging in age from 5 months to 16 years underwent surgical treatment for the Wolff-Parkinson-White syndrome at the Shiga University of Medical Science. None of the patients had any other associated congenital heart disease. There was a right free wall accessory pathway in four patients and a left free wall accessory pathway in three. Surgical ablation of these accessory pathways was performed on eight occasions, using the endocardial approach three times and the epicardial approach five. All the children are alive and none has since had episodes of tachycardia. Only one patient had a recurrent delta wave, which was noted 18 months after the operation. Surgical ablation of the accessory pathway for the Wolff-Parkinson-White syndrome can be performed safely, even in infants and children; it is concluded that this useful procedure is capable of improving a patient's quality of life.

Acute extensive necrosis of the visceral organs after repair of a ruptured thoracic aortic aneurysm

A 47-year-old woman was admitted to our hospital for repair of a ruptured thoracic aortic aneurysm. Her post-operative course was uneventful, but she had persistent complaints of anorexia and general fatigue that failed to improve. Thirty-one days after surgery, she complained of severe abdominal pain. Abdominal computed tomography (CT) and X-ray revealed extensive necrosis of the visceral organs. She underwent emergency abdominal exploration and was found to have necrosis of the liver, gallbladder, stomach, entire small bowel and colon. The extensive necrosis made resection of the involved organs unfeasible. The patient died one day after exploratory laparotomy.

[Experimental studies on retrograde cerebral perfusion: efficacy of clamping of the venous blood flow through IVC cannula]

Retrograde cerebral perfusion (RCP) is used to prolong the safe period of circulatory arrest under profound hypothermia. However, this technique now varies in some maneuvers at different institutions. This study investigated the effects on cerebral metabolism of clamping blood flow through the IVC cannula during RCP using fourteen adult mongrel dogs. During circulatory arrest, RCP by way of the bilateral internal maxillary vein was performed. In seven dogs, blood flow was drained through IVC cannula (IVC-drained group) and in the other seven dogs, the blood flow was clamped during RCP (IVC-clamped group). During RCP, the percent of returned blood volume, oxygen consumption, exudation of carbon-dioxide, and oxygen saturation of the returned blood were significantly higher in the IVC-clamped group than in the IVC-drained group, and the concentration of serum CK-BB in the IVC-clamp group was significantly lower than in the IVC-drained group. However, there was no statistical difference between the two groups concerning the regional cerebral blood flow or water content of the cerebral tissue. Concerning about these results, a part of perfused blood passed through not only the extra cranial veno-venous connection but also the intra cranial veno-capillary-venous connection. We concluded that clamping of the venous blood flow through the IVC cannula during RCP is a more protective procedure for cerebral tissue.

Enhanced expression of interleukin 6 in rat and murine arthritis models

Interleukin 6 (IL-6) is a multifunctional cytokine and plays an important role in host defense mechanisms. Enhanced production of IL-6 has been reported in polyclonal B-cell abnormalities and autoimmune diseases such as rheumatoid arthritis (RA). To investigate the role of IL-6 inflammatory joint diseases, serum IL-6 levels of three animal models of RA, namely type II collagen (CII)-induced murine, rat arthritis and adjuvant-induced rat arthritis, were monitored. In these models, serum IL-6 increased with the development of arthritis. Serum IL-6 was not elevated by immunization with a non-arthritogenic immunogen such as bovine type I collagen (CI) and bovine serum albumin (BSA) to DBA/1J mice. The serum IL-6 level was correlated well with the severity of adjuvant-induced arthritis. The elevated IL-6 in sera may be associated with the overproduction of IL-6 at the arthritis paws, because higher IL-6 activity was detected in the homogenates of arthritic paws as compared with the control paws. Synovial fibroblasts were isolated from the arthritis knee joints of DBA/1J mice. These cells expressed type I interleukin 1 (IL-1) receptor constitutively and produced large amounts of IL-6 in response to IL-1 in vitro. Enhanced production of IL-1 was also detected at the arthritis paws. These results suggest that the elevated IL-6 in sera may be associated with the overproduced IL-6 in response to the increased IL-1 at the arthritic joints. Serum IL-6 may be a useful parameter for monitoring disease activity.

[Removal of infected transvenous electrodes requiring cardiopulmonary bypass or extraction sheath]

Infection of four transvenous pacemaker electrodes were experienced in three patients and removed them using different techniques. The first patient had two infected electrodes. One was removed by direct traction and the other required cardiopulmonary bypass for its removal. In the second patient, one electrode was removed using a new extraction system called 'Lead Removal Kit' without thoracotomy. In the third patient, the kit was used during cardiopulmonary bypass. All these patients survived and none had recurrent infection. Our experiences proved that this Lead Removal Kit can minimize the risks for the removal of the infected pacemaker electrodes.

Effect of a novel anti-rheumatic drug, TA-383, on type II collagen-induced arthritis--suppressive effect of TA-383 on interleukin 6 production

We have evaluated the effect of a novel anti-rheumatic drug, cis-2-(4-chlorophenyl)-4,5-diphenyl-2-imidazoline hydrochloride (TA-383), on type II collagen (CII)-induced arthritis in DBA/1J mice. Treatment with TA-383 (0.4 mg/kg/day) from the day of immunization with CII strongly suppressed the arthritic responses. Increased serum interleukin 6 (IL-6) level was lowered in parallel with the effect. Effect of TA-383 on IL-6 production was examined in vitro. TA-383 inhibited the production of IL-6 by murine synovial fibroblasts stimulated with recombinant interleukin 1 (IL-1) beta in a dose-dependent manner (0.1-10 microM). Neither the general protein synthesis nor the expression of type I IL-1 receptor was affected by TA-383. The results show that TA-383 possesses an inhibitory activity on IL-6 generation and suggest that the effect may partly contribute to the anti-arthritic effect of TA-383.

Antitumor activity of Langerhans cells in radiation therapy for cervical cancer and its modulation with SPG administration

Correlations between infiltration of Langerhans cells (ILC) in tumor tissues and radiation curability were investigated in 449 patients with cervical cancer treated with radiation alone, including 390 squamous cell carcinomas and 59 adenocarcinomas. No significant difference in prognosis was noted in stage I, II, and IV squamous cell carcinomas between positive and negative ILC. However, in the patients with stage III squamous cell carcinoma, a significantly better survival was observed for patients with ILC than for those without, 10 year survival rates being 78% vs. 54%, P < 0.01. In adenocarcinoma, the patients with ILC also showed significantly better survival than those without ILC, the 10 years survival rates being 45% vs. 25%, P < 0.025. An analysis of failure patterns following radiation treatment demonstrated that the favorable prognosis in patients with ILC in squamous cell carcinoma was due to improvement of local control rates and somewhat lower metastatic rates, whereas in adenocarcinoma it was only due to better local control rate. The ILC was significantly associated with T-cell infiltration in tumor tissues. The immunological stimulation with Sizofiran in 20 patients led to an augmentation of ILC in tumor tissues. The present study suggests that the ILC in cancer tissues improves local response to radiation treatment partly by T-cell mediated anti-tumor activity.

[Surgical treatment of unroofed coronary sinus]

We have experienced four cases of unroofed coronary sinus. Three cases were partial forms and one case was a complete form. Two of them were successfully diagnosed before operation. Surgical viewpoints were discussed. In the absence of LSVC, the coronary sinus defect may be simply closed. In the cases with PLSVC, several types of repair were discussed. It has been reported that this defect is usually associated with simple or complex cardiac malformations, including tricuspid atresia or tetralogy of Fallot. In our case with TA, oversight of this anomaly before and during operation resulted in the urgent reoperation. A surgeon should always keep in mind this anomaly, even if the coronary sinus is not large.

A computer simulation of the plasma leakage through a vascular prosthesis made of expanded polytetrafluoroethylene

We explored the blood-retaining mechanism of a vascular prosthesis made of expanded polytetrafluoroethylene through analysis of its structure and physicochemical properties. Plasma leakage through this vascular prosthesis was simulated by computer to explore its etiology. These examinations disclosed that leakage is dependent upon the inner pressure and the density of fibers. In other words, the study revealed that the mean distance between fibers constituting the wall of the expanded polytetrafluoroethylene vascular prosthesis is increased by tension (that is, inner pressure), resulting in an increased probability of leakage. It was additionally found that a thin membrane is formed on the polytetrafluoroethylene surface if blood in contact with the surface is dried. This membrane was found to reduce the water-repelling property of polytetrafluoroethylene and to make it impossible to preserve the inter-fiber liquid surface, thus causing leakage through the expanded polytetrafluoroethylene vascular prosthesis.

[Facial nerve paralysis induced by herpes simplex virus infection in mice]

The etiology of Bell's palsy remains unknown but clinical serological investigations have suggested herpes simplex virus (HSV) induced facial neuritis to be a potential cause. In order to verify the viral etiology of Bell's palsy it must be proved by animal experimentation. The author first succeeded in producing a transient facial paralysis of mice, with a herpes simplex viral neuritis simulating human Bell's palsy. Type 1 HSV (strain KOS, 4.5 X 10(6) pfu/ml) was inoculated into the posterior aspect of the auricle. Fifty-nine out of 104 mice (56.7%) developed facial paralysis, on the experimental side, 6 to 9 days after the inoculation. The facial paralysis continued for 3 to 7 days and resolved spontaneously. In 36.8% of the animals with facial palsy, HSV antigens were identified mainly in the geniculate ganglion cells, satellite cells, Schwann cells and nerve fibers of the involved side using immunohistochemical methods. No HSV antigen was demonstrated in the facial nerve of the contralateral side in animals with facial paralysis, bilateral facial nerves in animals without facial palsy or in control animals. Histopathologically, the involved nerve showed findings of viral neuritis such as round cell infiltration and vacuolar degeneration of nerve fibers. Inflammatory changes were noted in and around the geniculate ganglion but were more pronounced in nerve fibers proximal to the ganglion. These findings persisted for as long as a month after normal facial function had been restored.(ABSTRACT TRUNCATED AT 250 WORDS)

[An outbreak of Pseudomonas sepsis associated with nosocomial infection in a pediatric ward]

A five-year old girl, diagnosed with fever of unknown origin (FUO), was transferred to our hospital due to a deterioration in her general condition. Pseudomonas cepacia (P. cepacia) was detected in her blood culture and she soon recovered after imipenem cilastatin (IPM/CS) administration. When the former hospital was informed of the results of her blood cultures, we learned that five other cases of FUO had occurred there within the previous two weeks in noncompromised children. Except for one case, Pseudomonas species was detected in their blood cultures. P. cepacia was found in one case, Pseudomonas aeruginosa (P. aeruginosa) was detected in two other cases, and both P. cepacia and P. aeruginosa were demonstrated in the other patient. Although the origin of the bacteria is unknown, it may have spread to the children through a contaminated liquid reservoir or medical devices.

[Pulmonary hemodynamic effects of cold pressor test in patients with chronic lung disease]

Cold Pressor Test (CPT) was applied to patients with chronic lung disease, including primary pulmonary hypertension, and the effects on pulmonary circulation were compared to those on systemic circulation. HR PPA, and TPR showed maximum values at the end of CPT (Time = 0) and recovered to baseline values 5 min after CPT. CO, however, did not change significantly after CPT. PPA and PAR showed maximum values at the end of CPT and then gradually decreased, but still were significantly higher than baseline values at 5 min after CPT. Nifedipine (NFP) reduced the maximum values of both TPR and PAR at the end of CPT. There was significant correlation between PPA change after CPT and baseline PPA value, and NFP decreased the slope of the regression line. These results indicate that cold stimulation induces both systemic and pulmonary vasoconstriction in patients with chronic lung disease, and this pulmonary vasoconstriction was correlated to the baseline pulmonary vascular tone. Moreover, nifedipine may reduce this cold stimulation-induced pulmonary vasoconstriction.

Experimental vestibular neuritis induced by herpes simplex virus

An animal model of vestibular neuritis was developed by inoculating herpes simplex virus type 1 (HSV-1) in the auricle of a mouse. Deviation of the body was observed in 4 of 30 mice 6 days after inoculation. These animals were sacrificed 6 to 10 days after inoculation and the vestibular nerve was examined histopathologically and immunohistochemically. The HSV-1 antigens were recognized exclusively in Scarpa's ganglion of the vestibular nerve in 2 of 4 mice in which signs of vestibular involvement were manifested.

[A successful two-staged Fontan procedure for tricuspid atresia with bilateral superior venae cavae and left pulmonary arterial stenosis]

A 10-year-old boy with tricuspid atresia (type I-b), bilateral superior venae cavae and left pulmonary arterial branch stenosis was treated successfully by a two-staged Fontan procedure. At 7 years of age, left Glenn shunt was performed after creation of a communicating vessel between the right and left superior vena cava, using a GORE-TEX graft of 10 mm of diameter. Three years later, after having confirmed graft patency, Fontan procedure was achieved without any problems. We think the innominate vein creation by an artificial material was a key design for the following successful two-staged Fontan procedure in this case.

Measurement of Grinding Temperature of Ceramics Using Infrared Radiation Pyrometer with Optical Fiber

The grinding temperature in the surface layer of a ceramic workpiece was measured using an IRP (infrared radiation pyrometer) connected by means of an optical fiber. Two types of optical fiber were employed: fluoride fiber and chalcogenide fiber. Si3N4, SiC, and Al2O3 were used as the work materials. The output waves of I.R.P. of Si3N4 and Al2O3 appear as curves with many peaks which are related to the infrared energy emitted from the cutting grains, but that of SiC shows no peaks at all. The highest grinding temperature was obtained in the case of Si3N4 whose grinding power is the largest of these three materials. The temperature distribution in the surface layer of the ceramics was much different from that of the steel.

Nitrotriazoles bearing sulfur-substituted side chains: preparation and characterization as hypoxic cell radiosensitizers

A series of 3-nitro-1,2,4-triazole (NTA) derivatives with -(CH2)mC(= Y)NH(CH2)nZCH3(Y, Z = O or S; m = 1 or 2; n = 2 or 3) group in the side chain at the N-1 position of NTA and their fluorinated analogs were synthesized. Their physicochemical properties and radiosensitizing activities in vitro and in vivo were investigated with respect, particularly, to the effects of sulfur substitution on the side chain of triazoles. The sulfur substitution of the oxygen atom in the side chain of NTA derivatives increased the partition coefficient (P value), but had little effect on the one-electron reduction potential. The derivatives bearing a thioether group in the side chain were more effective in vitro on hypoxic EMT6/KU cells, but were less effective in vivo on SCCVII tumor than their oxygen analogs. The thioamide compounds showed almost the same or slightly higher sensitizing activities in vitro compared with their oxygen analogs.

Evaluation of blood flow at ocular fundus by using laser speckle

We report a method for noninvasively evaluating blood flow at the ocular fundus by using laser speckle phenomena. The intensity fluctuation of speckles scattered from a 1-mm-diameter illuminated area at the fundus is detected and analyzed by the photon-correlation technique, which gives us the relative degree of total blood flows within the probe area. The method is used to evaluate blood flows at the ocular fundus of a rabbit and normal human volunteers. The experimental results show that the present laser speckle method is useful for the relative evaluation of blood flows in the ocular fundus tissue.

[Clinical study on cough variant asthma]

Chronic cough may be the sole presenting manifestation of bronchial asthma (reference 3; Corrao et al, 1979), and "cough variant asthma (CVA)" has been used to categorize such patients. In order to clarify the clinical picture of CVA, we evaluated the clinical history, laboratory data, sputum cytology and pulmonary function in 14 subjects (5 males and 9 females, aged 14 to 65 years) compatible with the following diagnostic criteria: (1) chronic cough persistent for more than 8 weeks, (2) no wheeze nor dyspnea, (3) no rales, (4) no past history of asthma, (5) bronchial hyperreactivity to methacholine proven by Takishima's method (reference 13), (6) effectiveness of bronchodilators against cough, (7) normal chest X-ray film, (8) afebrile and negative CRP, (9) absence of sinusitis and postnasal drip, or if present, they are proved not to be responsible for the cough, and (10) no other causes of cough such as heart disease, prescription of ACE inhibitors, current smoking. The results were as follows. 1) Many of the subjects were atopic, with positive skin tests to one or more common allergens in 10 subjects, elevated serum IgE in 4 subjects, and past history and family history of atopy in 4 and 7 subjects, respectively. 2) Respiratory infection preceded the onset of CVA in 3 subjects. 3) Cough was generally nocturnal, but 2 subjects coughed only in the daytime. 4) FEV1.0% was decreased (less than 70%) in only 2 subjects, whereas V25 was decreased (less than 80% of predicted value) in 11 out of 12 evaluable subjects, which suggested peripheral airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)