An impaired function of the myocardial beta-adrenergic receptor system has been reported in patients with end-stage heart failure and this impairment has been postulated to be a factor in further deterioration of cardiac contractile function. As ventricular dysfunction is often associated with prolonged alcohol abuse, we investigated whether or not chronic administration of ethanol could induce alterations in the beta-adrenergic receptor adenylate-cyclase system in rats. Male Wistar rats of 8 weeks of age received 33% ethanol in drinking water for 3 months. As compared with control rats drinking water, the ethanol-treated rats showed weight loss and an increase in the heart/body weight ratio. Chronic ethanol increased myocardial contents of norepinephrine and epinephrine, possibly resulting from sympathoadrenal activation. The beta-adrenergic receptor density (Bmax) of the myocardial membrane was significantly decreased in the ethanol-treated rats (27.7±9.9 vs 39.0±6.0 fmol/mg protein, p<0.01), while the affinity (Kd) did not differ between the two groups. The myocardial content of cyclic-AMP was also reduced in the ethanol rats (865±59 vs 1055±83 pmol/g w.w., p<0.01). These observations indicate that chronic ethanol administration depresses the function of the beta-adrenergic receptor adenylate-cyclase system. The decreased beta-adrenergic receptor density was partly attributed to down-regulation due to increased sympathetic stimulation. This impaired function may contribute to the cardiac contractile dysfunction observed in chronic alcoholics.
Cholelithiasis is extremely unusual in infants and children. Recently, some cases of cholelithiasis associated with total parenteral nutrition (TPN) have been reported. A group of 400 children receiving TPN were evaluated prospectively for the presence of gallstones and sludge in this report. Eight children (2%) were determined by ultrasonography to have developed cholelithiasis. All of these patients had received large amounts of amino acids (≥1.8g/kg/day) and relatively low amounts of fat (≤1.7g/kg/day) with a high ratio of non-protein: kcal/ml (>0.8). It was concluded that the administration of large amounts of amino acids and a high ratio of non-protein: kcal/ml enhanced the risk for formation of gallstones and sludge. Conversely, these are prevented by the administration of appropriate amounts of fat.
Torsion of the gallbladder in a child is rare and only 23 cases in children have been reported in Japan. A preoperative diagnosis is very difficult and only four cases have been diagnosed, preoperatively, to date. In the case reported here the suspected preoperative diagnosis was an acute cholecystitis. During the operation, the gallbladder was found to be enlarged to twice the normal size and twisted 540 degrees in a clockwise direction around the cystic duct. A cholecystectomy with abdominal drainage was successfully performed; and the patient was discharged in good condition, 13 days after the operation. It was concluded that one of the most important features for the preoperative diagnosis of torsion of the gallbladder is a dislocation on ultrasonography.
Two cases with ectopic pregnancy were successfully treated by laparoscopic injection of methotrexate (MTX). Case 1: A 29 year-old housewife was laparoscopically treated with a 15 mg MTX injection to the left Fallopian tube. After the laparoscopy, the human chorionic gonadotropin (HCG) was reduced to the normal range. Case 2: A 34 year-old housewife was also laparoscopically treated with a 35 mg MTX injection to the right Fallopian tube. After the laparoscopy, the HCG was quickly reduced to the normal range. The endoscopic approach can be used as the surgical treatment of choice for ectopic pregnancies.
A patient with a higherly positioned and large basilar bifurcation aneurysm associated with bilateral internal carotid occlusion was described. A 63 year-old man was admitted to Yokokura Hospital with disturbed consciousness and mild left hemiparesis. On admission, an initial plain CT-scan showed an acute obstructive hydrocephalus with periventricular lucency caused by an abnormal lesion in the anterior part of the third ventricle. An emergency ventriculo-peritoneal shunt was inserted. The postoperative course was uneventful. The patient regained his consciousness with normal motor function by the following day. Postoperative cerebral angiography disclosed a large basilar bifurcation aneurysm at a higher position, 19 mm from the dorsum sellae. Bilateral internal carotid occlusion had occurred, but rich collateral blood supply from the vertebrobasilar artery via the bilaterally enlarged posterior communicating arteries to the anterior circulation was observed. This rich collateral blood supply to the vertebrobasilar artery might be responsible for the development of the aneurysmal formation due to the increased hemodynamic stress.
The positive rates of the second-generation enzyme-linked immunoassay (2nd-generation assay), and two first-generation immunoassays (C100-3 and KCL-163 assay) to test for anti-HCV antibodies in the serum of patients with non-A, non-B chronic liver disease were determined. The clinical usefulness of these assays was also evaluated. The group positive for the 2nd-generation assay alone was compared with that positive for the 2nd-generation and C100-3 assays with respect to the serum GPT levels determined simultaneously with the antibodies. The latter group showed slightly higher GPT levels. These findings suggest that the 2nd-generation assay is useful for the diagnosis of hepatitis C, and that C100-3 and KCL-163 assays are useful indicators of the activity of hepatic disorders.
A retrospective case-control study was carried out on patients with hepatocellular carcinoma (HCC) admitted between 1976 and 1985 to analyze the relationship between the cancer and risk factors. The following conclusions were reached: 1) the positive rate of Hepatitis B surface (HBs) antigen among the HCC patients decreased from 41% in the period 1976-1980 to 19% in the period 1981-1985. However, the risk of the patients positive for the antigen for HCC was higher in the second period (1:18.7) than in the first period (1:12.8), 2) drinking not only enhanced the risk for HCC 2.7 times, but also accelerated the onset of HCC by about 5 years, 3) blood transfusion enhanced the risk for HCC; HCC occurred in about 20 years on average after blood transfusion in the patients negative for the hepatitis B virus (HBV) and drinking history, and 4) smoking was suggested to be less related to the onset of HCC.