A study of 122 cases of pancreatic cancer diagnosed by endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is a highly accurate and specific method for evaluating patients with suspected pancreatic disease. Its diagnostic significance of specific pancreatographic signs is of even greater importance. We reviewed 122 cases of pancreatic cancer who were done ERCP, at the Department of Internal Medicine, Yonsei University, College of Medicine between June 1973 and August 1983. The results were as follows: 1. The ages of 122 patients ranged from 27 to 76 with the majority in the 6th and the 7th decades. The male to female ratio was 2.49:1. 2. The success rate of cannulation into the orifice of the duodenal papilla in 122 cases was 97.5% (119/122), and the pancreatic duct was visualized in 91.0% (111/122). 3. Diagnostic accuracy of ERCP in pancreatic cancer was 96.4% (107/111) among cases in whom the pancreatic duct was visualized. 4. By ERCP the most common site of the lesion was head of pancreas (51.4%). 5. According to Fukumoto’s classification, the most common type was obstructive type (65.4%), followed by the stenosing type (29.0%), abnormal branching type (3.7%), and narrowing type (1.9%). 6. According to Takaki’s classification, Type I (obstruction or stenosis of the main pancreatic duct) was most common (85.6%), followed by Type III (pancreatic dilatation) (9.0%), Type IV (normal pancreatic duct) (3.6%), and Type II (obstruction of Wirsung’s duct or Santorini’s duct) (1.9%). 7. Of the 122 cases of pancreatic cancer, the bile duct was visualized in 55 and abnormalities, such as indentation (32.1%), stenosis (42.9%), and obstruction (25.0%) were found in 28. The locations of abnormal findings in the bile duct were distal (50.0%), middle (46.4%), and proximal (3.6%).

Nonconvulsive status epilepticus. Ictal confusion in later life

In 11 patients without histories of absence seizures, acute prolonged confusion and/or prominent psychiatric manifestations occurred between the ages of 42 and 76 years, and were accompanied by 1 to 2.5-Hz generalized spike-wave or multiple spike-wave discharges in the EEGs. The patients were successfully treated with intravenously administered diazepam followed by orally administered phenytoin sodium and/or phenobarbital. The ictal confusion in later life seems to be an entity distinct from the typical petit mal status of early onset.

Pattern-reversal visual evoked potentials in photosensitive epilepsy

VEPs to checkerboard pattern-reversal were recorded from 18 epileptic patients who had EEG photoparoxysmal responses to stroboscopic light. Patients were grouped according to whether seizures were precipitated by environmental light stimuli, or television viewing. Longitudinal studies were conducted on 8 patients treated with valproic acid. We concluded the following: (1) Latency of the major positive peak (P2) of the pattern-reversal VEP was shorter among photosensitive patients than among normal controls. This was especially true of television-sensitive patients. (2) Valproic acid, when effective in controlling seizures, lengthened the P2 latency and decreased VEP amplitude. Studies of drug effects on VEPs may help to elucidate neurochemical mechanisms of the visual cortex. (3) Because of overlap of values with normals, VEP measurements are not at present very sensitive in the diagnosis of photosensitivity. However, longitudinal studies in individuals parallel clinical changes and may be useful as objective measures of improvement.

Combined effects of lead and EDTA on Na+,K+-ATPase activity of erythrocyte membranes

Erythrocyte Na+,K+-ATPase activity increased significantly in lead workers of a lead refining factory when measured with EDTA and compared to the controls without EDTA. The enzyme activity measured with EDTA increased in the following order: controls less than office workers in a lead refining factory less than lead workers. A positive correlation existed between blood lead and enzyme activity with EDTA (r = 0.380, p less than 0.10), and the activity without EDTA (r = 0.398, p less than 0.05). A negative correlation was found between sodium in erythrocytes and enzyme activity with EDTA (r = -0.437, p less than 0.05), and the activity without EDTA (r = -0.416). But no relationship was observed between enzyme activities and potassium in erythrocytes. A positive correlation between enzyme activity with EDTA and that without EDTA was observed (r = 0.452, p less than 0.05). With addition of lead to fragments of erythrocyte membranes, a significant decrease occurred in the activity of the enzyme without EDTA, whereas no change was observed with EDTA. No significant change occurred in the enzyme activity with and without EDTA upon addition of lead to blood. The maximum level of lead in membrane fragments (lead combined with membranes) of workers exposed to lead was 0.60 microgram/mg protein, and that in the experiment of addition to blood was 7.0 micrograms/mg protein.

Patterns of wet suit diving in Korean women breath-hold divers

Work shifts, diving pattern, diving lung volumes, and counterweights were studied in professional Korean women breath-hold divers wearing wet suits. One of the major differences, compared with their diving pattern only a few years ago when wearing cotton suits, is the prolongation of the diving shifts from 70 to 180 min in the summer and 10 to 120 min in the winter. In sustained diving the average dive and surface times in a 5-m dive are 32 and 46 s, and in a 10-m dives, 43 and 85 s, respectively. During a 3-h shift the total bottom time for harvesting is 37 min in 5-m dives and 17 min in 10-m dives. Rates of descent and ascent are 0.55 and 0.84 m/s. The wet suit divers adjust their counterweights to obtain a 12% positive buoyancy at the surface of sea water in contrast to the 8% positive buoyancy of cotton suit divers. The average lung volumes before and after a dive are 79% and 64% of their vital capacities, values similar to those of previous cotton suit divers.

Coexistence of triphasic waves and alpha-coma pattern

The coexistence of triphasic waves and alpha-coma pattern in an EEG was observed in a 67-year-old comatose man following cardiopulmonary arrest, while his brain stem functions were intact. Although they may be diagnostically and prognostically significant, these EEG findings can be hard to recognize. These two distinct EEG patterns do not seem to be mutually exclusive.

Experiments with banana trunk juice as a neuromuscular blocker

The juice of the banana trunk produces a non-depolarising neuromuscular block. Oxygenation of the extract enhances its potency. Reversals with anticholinesterases are transient. Partial reversals in isolated preparations indicate these could be both specific and non-specific binding which could account for blockade after washing. It could be specifically bound to ACh receptors in an irreversible way since its action appears similar to that of alpha-BuTX.

Seizures induced by playing music

A 67-year-old organist and minister with diabetes mellitus had stereotyped focal seizures of the left lower face, jaw, and neck. Attacks occurred spontaneously or were induced when he played a specific hymn on the organ. The seizures were not induced by reading, singing, hearing, or playing the hymn silently. The patient had interictal weakness of the left lower face and left side of the tongue. Focal seizures were recorded on an electroencephalogram (EEG) at the right temporofrontal area. This patient illustrates partial seizures induced by playing music.

Language-induced seizure. A case of cortical origin

After anastomosis of the superficial temporal to the middle cerebral artery, partial motor seizures referable to the left inferior motor strip and Broca's area developed in a 48-year-old man. These seizures were readily induced by attempts to speak, to read silently or aloud, and to write. The seizures were not induced by simple movements of the ocular, facial, jaw, throat, and extremity muscles, primary sensory stimuli, or higher intellectual function such as calculation. The patient had nonfluent dysphasia, but he had no comprehension disorder. A clear focal onset of electrographic seizures was recorded maximally at the left temporal region on reading aloud and at the left central area on writing. The cerebral evoked potentials were mildly abnormal on the affected hemisphere. This case shows cortical onset of language-induced seizure.

A multivariable evoked potential measure applied to human epilepsy

Based upon a three-dimensional plot (response plane) representing a condensation of human sensory evoked potential data obtained from a paired stimulus protocol, a study was undertaken to investigate electrophysiological changes following sodium valproate administration in subjects with photosensitive epilepsy. Initial results in two patients and two normal subjects suggest that the measure is reproducible and sensitive to electrophysiological changes accompanying anticonvulsant administration.

Visual evoked potentials to stimulus trains: normative data and application to photosensitive seizures

Visual evoked potentials (VEPs) to intermittent flash trains of various stimulus frequencies (VEP-T) were studied in 10 normal subjects and in 10 patients with photosensitive generalized seizures, 5 on medication and another 5 subjects without medication. In the normal group, early negative peaks were consistently demonstrated at 71 +/- 8 msec for monocular stimuli and 67 +/- 9 msec for binocular stimuli, regardless of different frequencies of stimuli. An oscillatory potential, poststimulus continuation of the oscillatory activity and damping out within 100 msec followed the initial peaks. The RMS values of the response epochs were stable and demonstrated consistent temporal changes at each stimulation frequency. In photoconvulsive seizures, the responses were facilitated with most marked changes over the second and third 125 msec epoch of the VEP-Ts with late slow negative deflections in some cases. These changes were pronounced in patients who were not taking anticonvulsant medication, but were not significantly different than controls in patients whose seizures were controlled with medication. It is suggested that the VEP-T is a more effective technique than single flash stimuli in consistently identifying early significant peaks and demonstrating neuronal excitability changes within the visual system.

Stupor following administration of valproic acid to patients receiving other antiepileptic drugs

Stupor is an unusual complication following the addition of valproic acid to other antiepileptic drugs. We report four such cases. Stupor occurred acutely in 3 patients and insidiously in the fourth. In the cases of acute toxicity, neither toxic levels of valproate nor significant elevations in blood levels of the other drugs occurred. In the fourth patient, stupor occurred concomitantly with a rise in the phenobarbital level. The electroencephalograms of all 4 patients revealed generalized high-amplitude rhythmic bisynchronous delta activity. Recovery occurred following discontinuation of valproic acid or other antiepileptic drugs. These observations suggest that stupor may occur as a result of drug interactions after the addition of valproic acid to other antiepileptic drugs.

Acute prolonged confusion in later life as an ictal state

Six patients ranging in age from 42 to 69 with no prior history of seizure disorder presented an acute prolonged or intermittent confusional state, with or without psychotic symptoms, as an ictal manifestation. The EEGs demonstrated protracted generalized spike and wave discharges, but full diagnostic evaluation disclosed no evident cause for the seizures. All promptly responded to small amounts of intravenous diazepam and subsequent oral phenytoin and phenobarbital. Three of the six patients had focal spike or sharp wave discharges on EEGs recorded subsequently, suggesting that the episodes may reflect secondary generalized seizures in some cases. These cases do not fit in the classic category of petit mal status and appear to be a distinct entity.