A 67-year-old female was emergently admitted to our hospital because of severe dyspnea with cyanosis. One month before admission, she consulted a doctor and chest x-ray disclosed a huge tumor shadow occupying most of the left hemithorax. At that time, she did not complain of any particular symptoms except slight cough. Twelve days after admission, the patient lost consciousness and an emergency operation was performed. The tumor showed severe adhesion to the aorta and the lower lobe of the left lung, but not to the esophagus. After the operation, mechanical ventilation was necessary for 13 days to recover pulmonary function. Histological diagnosis was made as leiomyoma, which is rarely seen in the mediastinal region. At present, the patient survived 10 years without any symptom of recurrence. In this paper, the authors report a case of mediastinal leiomyoma which received an emergency operation and attained long term survival. Twelve similar cases reported in the past were also reviewed.
We applied the absolute ethanol injection method in 182 cases of massive bleeding with hemorrhagic shock before the performance of emergency endoscopy in 627 cases of upper gastrointestinal bleeding at our department and five related institutions since June 1979. Following results were obtained: Temporary hemostasis could not be obtained in only 2 (1.1%) out of 182 cases; in the remaining 180 cases bleeding was ceased. Rebleeding was seen in 15 cases (8.2%) and new bleeding in 17 cases (9.3%). In 21 (66%) of these cases hemostasis was obtained again by the absolute ethanol injection method. Eight patients (4.4%) underwent emergency operation and 4 patients (2.2%) died from bleeding. The complete hemostasis was obtained in 170 cases (93.4%).
The mechanical properties of the longitudinally cut preparations of the guinea-pig hepatic duct were studied. About 42% of the preparations (18 of 43 preparations) showed spontaneous phasic contractions which were unaffected by either tetrodotoxin, guanethidine or atropine. About 60% of them exhibited phasic contractions which appeared at irregular frequencies in the same tissue and varied in size. This sort of contractions usually accompanied small contractions. In about 20%, contractions occurred constantly in frequency (about 6-14 every 10 min) and in size. The remaining 20% showed twitch-like contractions which occurred sporadically. These contractions were classified into two types depending upon the susceptibility to the Ca2+ entry blocker, D-600. D-600 (1-100μM) strongly suppressed both regularly occurring contractions and twitch-like ones. On the other hand, the drug was ineffective on irregularly occurring contractions. The Ca2+ sources underlying these contractions were discussed.
Intravenous administration of bromoethylamine hydrobromide (BEA) has been shown to induce papillary necrosis of the kidney. We used this model to clarify the role of the medullary structure in acid-base homeostasis. BEA (25mg) or vehicle was injected to male Sprague-Dawley rats. Blood specimens and 24 hr urine were collected once a week totaling 4 weeks. Blood bicarbonate significantly decreased in BEA treated rats with no change in plasma creatinine or creatinine clearance at 3 and 4 weeks, we noted that these parameters did not change in control rats. Administration of 1 M NH4Cl solution (1ml/100g) into the peritoneal space resulted in a significant reduction in urine pH by 0.41±0.05 in control rats, whereas it did not induce any change in BEA treated rats. Ammonia excretion rates were significantly lower in BEA treated rats than in control rats. Histological examination showed that in BEA treated rats there was necrosis of epithelial cells of papillary collecting ducts at 1 week. Observation showed they recovered at 4 weeks with only mild interstitial edema and slight dilatation of collecting ducts. The present results suggested that tissue damages in the papillary structure caused metabolic acidosis due to a decreased renal acidification.
Tension lag time on electric stimulation (TLTe), i.e., latency from the stimulus to the rise of tension, and contraction time (CT) of the rectus femoris muscle on twitch contraction were measured on the affected and non-affected sides of eight patients with spastic hemiparesis due to stroke. Both TLTe and CT were significantly longer on the affected side than on the non-affected side, suggesting changes in contractile properties of the spastic muscle.
Forty-three infants (less than 12 months of age) underwent VSD closure without operative mortality between June 1982 and December 1987. Average age and body weight at the operation were 6.9 months and 5.3 kg, respectively. Associated cardiac anomalies were PDA (11 patients), ASD (5) and PS (1). Preoperative pulmonary to systemic peak pressure ratio (Pp/Ps), resistance ratio and flow ratio, and pulmonary vascular resistance were 0.79±0.15, 0.29±0.16, 2.52±0.60 and 3.05±1.94 unit•m2, respectively. VSD was closed under combined surface/ perfusion hypothermia with total circulatory arrest in 25 patients and standard cardiopulmonary bypass in 18. All patients were discharged from the hospital in good condition, but there was one late death due to pneumonia. Postoperative Pp/Ps decreased to 0.39±0.11. Most of the patients demonstrated satisfactory body weight gain after VSD closure. These results support our current policy of aggressive surgical intervention for refractory VSD in the early stage of life.
To identify whether the incidence of human papillomavirus (HPV) type 18 DNA in adenocarcinoma and adenosquamous carcinoma is attributable to the histological types or geographical differences, the presence of HPV-16 and HPV-18 DNA in carcinoma of the uterine cervix from Japan were studied by in situ hybridization using tritium labeled HPV DNA probes. HPV-18 DNA was detected in 5 of 11 cases (45%) of adenocarcinoma, one case of adenocarcinoma in situ and 2 of 3 cases of adenosquamous carcinoma. In contrast, HPV-16 DNA was detected in 2 of 11 cases (18%) of adenocarcinoma, and 3 of 7 cases (43%) of squamous cell carcinoma. Compared with our previous results (Tase et al. 1988), the present results imply that the prevalence of HPV-18 DNA in carcinoma of the uterine cervix is attributable rather to the histological differences than to the geographical differences.
We aimed to investigate the modifying effect of dietary protein level on the estimation of 24-hr creatinine excretion using anthropometric measurements, in a group of 40 healthy Japanese adults, during usual daily life. To evaluate the variability of each measurement during non-restrictive life, we assayed 24-hr urinary excretions of creatinine and urea-N and measured heights and weights once in every three months in a total of 4 times during a year. Urinary urea-N was used as a marker of dietary protein level. Seasonal variability of anthropometrics and urinary excretions was observed on the individual basis. In comparison to the rather small individual variability of weight (mean of CV=1.2 for males, 1.7 for females), variability of urinary creatinine (CV=11.7, 8.4) and urea-N (CV=18.9, 17.3) took larger values. The creatinine excretion was estimated by the following two sets of predictor variables; (I) age, height and weight, (II) age, height, weight and urea-N. Although, a statistically significant estimation was obtained by (I), estimation (II) resulted higher regression coefficient than (I), and contribution of urea-N to the estimation of creatinine was shown. Average level of seasonal variability of each predictor variable was further applied to the regression equation (II). Therefore, the possible difference of 24-hr creatinine excretion caused by the seasonal variability of dietary protein level was estimated to be 9.2% for males and 3.6% for females in the given population. Thus, when one predicting formula of 24-hr creatinine by the use of anthropometrics is applied to other populations, the difference of protein nutritional status should be carefully considered.
The cardiac and coronary effects of AN-132, a new antiarrhythmic agent, were investigated in isolated, blood-perfused atrioventricular (AV) node, sinoatrial (SA) node and papillary muscle preparations of dogs. AN-132 was administered intraarterially. In AV node preparations, whether injected into the anterior septal artery (ASA; supplying the His-Purkinje-ventricular system) or the posterior septal artery (PSA; supplying the AV node), AN-132 prolonged AV conduction time and produced second- or third-degree AV block at large doses in some preparations. Moreover, only when injected into the ASA AN-132 produced a broadening and diminution of amplitude of bipolar electrograms obtained from the right bundle branch and the ventricular septum. In SA node preparations, AN-132 decreased sinus rate and produced atrial standstill at large doses in some preparations. In paced papillary muscle preparations, AN-132 reduced the force of contraction. In spontaneously beating papillary muscle preparations, AN-132 decreased the rate of automaticity and the force of contraction. In all preparations, AN-132 produced a transient increase in blood flow only at large doses. The order of potencies of AN-132 based on the doses that produced 15% suppressions of the above cardiovascular variables was as follows: cardiac muscle contraction > ventricular automaticity ≥ intraventricular conduction > AV nodal conduction ≥ coronary blood flow > SA nodal automaticity.
Effects of Furosemide (FM) on the ionic channels in the ganglion cells of Aplysia were investigated using a conventional electrophysiological method. Application of 1 mM FM for 30 min did not alter the resting membrane potential or conductance. Na+-dependent responses to acetylcholine (ACh) were slightly depressed but Cl--dependent responses to ACh and γ-aminobutyric acid (GABA) were markedly depressed by FM. On the other hand, K+-dependent responses to ACh and dopamine (DA), and cyclic adenosine-3', 5' monophosphate (cAMP)-dependent response to DA were not appreciably altered by 1 mM FM. The depressing effects of FM on both Na+-and Cl--dependent responses were due to the non-competitive inhibition of their receptor activities. It was concluded that 1 mM FM can change neither Na+-K+-pump nor Cl--pump mechanisms in the ganglion cells of Aplysia, but it depresses the receptor-operated Na+-and Cl--channel activities, the greater effect on the open Cl--channels. In addition, it was postulated that FM effect may be highly specific to the open state of Cl--channels regardless of whether the membrane is excitable or not.
In order to elucidate the role of the size (surface area) of the storage container in maintaining the oxidative metabolism of platelets during in vitro storage at 22°C, human platelets were stored as platelet concentrates (PC) with plasma in conventional polyvinylchloride plastic containers of various sizes for 3 days at 22°C. Oxygen permeability of the container was 1.5 nmole/min/atm/cm2. Levels of the partial oxygen pressure (PO2) of PC depended on both container size and total number of platelets. The larger the containers, the higher was the PO2. PO2 linearly decreased to 16 mmHg with increasing platelet number. In well-oxygenated PC, 93% of the total ATP production was through the oxidative phosphorylation. With further increases in platelet number in the container, PO2 maintained low levels. The increases in glucose consumption and concomitant lactate production occurred to compensate the oxygen debt. The pH fall in PC depended on the degree of glycolysis. The partial carbon dioxide pressure (PCO2) increased with increasing platelet number. However, the larger the container, the lower was the PCO2. When PC were stored in 6 different-sized containers, the number of platelets, at which PO2 was 16 mmHg, was correlated with the size of the container. The present data indicate that the amounts of oxygen entering a container, which depended on container size, may determine the number of platelets maintaining oxidative metabolism.
We measured lateral pressure in airways 3 mm in internal diameter in three normal subjects using an anterograde catheter with a tip micromanometer. The pressure was used to partition total pulmonary resistance into a large airway resistance component between the mouth and the pressure sensor and a small airway resistance component between the pressure sensor and alveoli. Large airway resistance and small airway resistance during inspiration were 2.3±0.4 and 0.9±0.2 cmH2O/liter/sec (mean±S. E.), respectively, and small airway resistance was 29% of the total pulmonary resistance. We suggest that the present technique may be useful for determining the localization of airway resistance in human subjects.