Assessment of autonomic nervous activity during gastrointestinal endoscopy: Analysis of blood pressure variability by tonometry

We continuously measured blood pressure by tonometry in 30 patients during endoscopy to determine the influence of upper gastrointestinal endoscopy on cardiac events. Patients were divided into two groups: one group treated with scopolamine butylbromide as premedication (SB group) and another group without premedication (C group). Time- and frequency domain analyses of beat-to-beat systolic blood pressure variability were performed for 128 consecutive beats. For time-domain analysis, we calculated the coefficient of variation of systolic blood pressure (CV_BP). For the frequency domain analysis, we determined the low-frequency (LF_BP; 0.04–0.15 Hz) and high-frequency (HF_BP; 0.15–0.40 Hz) powers of the variation in systolic blood pressure and the ratio of LF_BP to HF_BP (LF_BP/HF_BP) during endoscopy. The CV_BP and HF_BP, indicators of parasympathetic tone, increased in the early phase of endoscopy but decreased significantly in the middle and late phases compared with the pre-endoscopy value. The ratio of LF_BP/HF_BP, an indicator of indirect sympathetic tone, increased throughout the endoscopic procedure. Moreover, premedication with scopolamine butylbromide prevents the excessive parasympathetic nervous reflex when an endoscope passes through the upper digestive tract and also brings both decreased parasympathetic tone and increased sympathetic tone at the late phase of endoscopic procedure. Our results indicate that gastrointestinal endoscopy induced an autonomic nervous abnormality, which may contribute to the occurrence of cardiac events during endoscopic procedures.     

Molecular weight analysis of cow's milk antigens in neonate sera

Some food antigens (Ag) can be detected in serum immunoglobulin G (IgG) antibodies (Ab) following ingestion. These Ag may thus be essential for inducing the production of IgE or IgG antibodies, which may in turn lead to the onset of atopic diseases such as atopic dermatitis, allergic rhinitis and asthma. The molecular weights (MW) of these Ag have yet to be determined. To select samples for MW analysis of circulating food Ag, we measured the concentrations of cow's milk (CM) Ag in the sera of 88 neonates by radio-immunoassay. They were found present in 20 samples of the sera. Twelve of the samples were analyzed for Ag MW by immunoblotting. Several bands appeared for one of the samples. Their MW were < 13 000 and no native CM proteins could be detected.     

Diagnosis of the Depth of Advanced Gastric Cancer Invasion by Endoscopic Ultrasonography

Preoperative endoscopic ultrasonography (EUS) was performed in 272 patients with advanced gastric cancer who underwent gastrectomy between December 1986 and December 1993. We divided the subjects into two groups: group A consisted of patients whose stomachs were filled with water for the EUS examination (water-filling method: 1986.12–1992. 10) and group B of patients in whom EUS was performed with the water-filled balloon compression method (balloon-compression method) in addition to the water-filling method (1992.11–1993. 12). A comparative study of EUS diagnostic efficacy, as regards the depth of invasion, was made between group A and group B. The following results were obtained: 1) In group A, the depth of invasion of mass-forming type carcinoma was accurately diagnosed by EUS in 59.3% of patients with mp cancer, in 28.8% of those with ss cancer, in 78.8% of those with se cancer, and in 83.3% of those with si cancer. The accuracy rate in diagnosing the depth of invasion of wall-thickening type carcinoma was 46.2% in patients with mp cancer, 68.0% in those with ss cancer, 59.1% in those with se cancer, and 66.7% in those with si cancer. 2) In group B, the depth of invasion of mass-forming type carcinoma was accurately diagnosed by EUS in 70.6% of patients with mp cancer, in 68.4% of those with ss cancer, in 92.3% of those with se cancer, and in 100% of those with si cancer. The accuracy rate in diagnosing the depth of invasion of wall-thickening type carcinoma was 75.0% in patients with mp cancer, 72.7% in those with ss cancer, 76.5% in those with se cancer, and 100% in those with si cancer. 3) These results suggest that the diagnostic efficacy of EUS utilizing both the balloon-compression method and the water-filling method is greater, as regards the depth of advanced gastric cancer invasion, than EUS utilizing only the water-filling method.     

ALTERATION OF ACETALDEHYDE METABOLISM IN CARBON TETRACHLORIDE-INTOXICATED RAT LIVER: ANALYSIS USING LIVER PERFUSION SYSTEM

The hepatic metabolism of acetaldehyde in carbon tetrachloride(CCl₄)-intoxicated rats was studied using a non-recirculatinghaemoglobin-free liver-perfusion system. Acetaldehyde uptakeby the liver from acutely CCl₄-treated animals (4.16 mmol/kg,i.p.) at 24 hr after the treatment was not significantly altered,whereas that by the liver from chronically CCl₄-treated animals(2.08 mmol/kg,i.p., twice a week, for 8–12 weeks) wasdecreased by approximately 50% when it was determined in thepresence of 0.01–5 mM acetaldehyde. In liver from ratschronically intoxicated with CCl₄, the following important biochemicalchanges were observed: (1) The activity of low K_m aldehyde dehydrogenase(ALDH) in hepatic mitochondria was decreased by approximately75%. (2) The basal levels of the lactate/pyruvate (cytosolic[NADH]/[NAD⁺]) ratio as well as the ß-hydroxybutyrate/acetoacetate(mitochondrial [NADH]/[NAD⁺]) ratio were elevated by more than2-fold. (3) Mitochondrial NADH oxidation was also reduced byapproximately 35% of the control level. (4) The basal levelof hepatic oxygen uptake was attenuated by approximately 50%,and the infusion of acetaldehyde (0.01–5.0 mM) causeda further decrease in the uptake. (5) The rate of ethanol productionfrom acetaldehyde by the catalytic action of alcohol dehydrogenasewas found to be unaltered when low concentrations of acetaldehyde(0.01–0.2 mM) were used, whereas a significant suppressionof the rate of ethanol production was detected in the presenceof high concentrations of acetaldehyde (0.6–5 mM). Thesedata suggest that the changes in activity of the lowK_m mitochondrialacetaldehyde dehydrogenase and those in mitochondrial NADH oxidationcoupled with mitochondrial respiration may, at least in part,play important roles in the decreased hepatic acetaldehyde metabolismobserved in chronically CCl₄-treated rats.     

Impact of Atrial Fibrillation Termination on Clinical Outcome after Ablation in Relation to the Duration of Persistent Atrial Fibrillation

Background: Whether procedural termination of persistent atrial fibrillation (AF) is necessary for optimal clinical efficacy still remains controversial. We sought to characterize the patients with persistent AF in whom procedural AF termination impacted an improved clinical outcome after ablation. Methods: We retrospectively assessed 132 patients (61.0 ± 9.3 years, 114 males) undergoing catheter ablation of persistent AF (duration 3 years, median). A stepwise ablation approach including pulmonary vein isolation and atrial substrate ablation targeting complex fractionated and high‐frequency electrograms was performed with desired endpoint of AF termination. Results: Overall, 90 patients (68%) were free from recurrent arrhythmias at 20 ± 11 months of follow‐up after one or two procedures. The left atrial diameter and continuous AF duration according to medical history were associated with the outcome (P = 0.002 and P< 0.001, respectively). In multivariate Cox regression analysis, the continuous AF duration was the only independent predictor of recurrent arrhythmias (hazard ratio 1.17, 95% confidence interval 1.10–1.23, P < 0.001). In patients with AF duration of ≥3 years, the clinical success was comparable regardless of whether AF termination was achieved or not (log‐rank, P = 0.27). In the remaining patients with AF duration of <3 years, procedural AF termination was associated with a higher arrhythmia‐free rate than when AF was sustained after ablation (log‐rank, P = 0.023). Conclusion: Extensive ablation to terminate AF might not be warranted in patients with a longer AF duration. On the contrary, procedural AF termination could be associated with maintenance of sinus rhythm in patients with a shorter AF duration with a less proarrhythmic substrate. (PACE 2012;35:1436–1443)     

Endoscopic Detection Rate of Minute Neoplasms in Autopsied Colons

Abstract: This study was designed to determine the actual incidence, distribution and morphology of minute neoplastic polyps, under 5 mm in diameter, in the so-called normal colon obtained at autopsy. In order to increase the sensitivity of detection of minute lesions, this study was done with the aid of electronic endoscopy using the dye spraying method. The case-occurrence of minute neoplastic polyps among the 49 autopsy cases was almost 50% and the ratio of cases without adenomas or cancers of the colon was no more than 50%. The ratio of minute neoplastic polyps among the total number of neoplastic polyps, based on electronic endoscopy, was much higher than that of minute polyps of autopsy cases reported previously with macroscopic observation. Regarding the grade of atypia of the minute neoplastic polyps, only one polyp (5 mm in diameter) among 85 lesions was a carcinoma. The results of this study indicate the possibility of considerable numbers of minute neoplastic polyps which are likely to go undetected by endoscopy, probably due to technical difficulties in endoscopic control and the lack of sufficient examination time for each patient.     

Laparoscopic observation of retroperitoneal cystic lymphangioma

Abstract A case of retroperitoneal cystic lymphangioma observed laparoscopically is reported. In a 60 year old asymptomatic male patient, an 8 cm multi-loculated cystic lesion was detected incidentally near the splenic hilum with ultrasonography. Endosonography, computed tomography and magnetic resonance imaging revealed the lesion with thin wall and clear fluid.
Laparoscopy showed a thin-walled cyst with smooth surface, and straw-coloured clear fluid was observed through the wall. These findings suggested benign aetiology, and seemed to be characteristic of cystic lymphangioma. The tumour was resected, and microscopic examination showed proliferated lymph channels intespersed by lymph follicles. Diagnosis of cystic lymphangioma was established. Laparoscopy seems a useful pre-operative method.     

Spitz naevus of the toe

A 68-year-old Japanese woman presented with a brownish macule, containing two papules, on her left fourth toe. Histological examination revealed an intradermal epithelioid cell tumour with irregularly shaped, bizarre giant cells. In the upper portion of the tumour, the epithelioid cells contained abundant melanin. A low amount of 5-S-cysteinyldopa and a diploid DNA distribution histographic pattern were helpful in differentiating the lesion from malignant melanoma. This location of a Spitz naevus is exceptional.     

Outcomes of infants whose mothers are positive for human herpesvirus-6 DNA within the genital tract in early gestation

It has been reported that HHV-6 (human herpesvirus-6) DNA has been identified within the female genital tract. However, the clinical significance of this finding has been unclear. The clinical outcome of the presence of HHV-6 DNA in the genital tract of pregnant women on their infants was evaluated in the present study. One hundred and ten pregnant women were enrolled. Vaginal swabs were collected between 4 and 8 weeks of gestation and the presence or absence of HHV-6 DNA was evaluated by nested polymerase chain reaction (nPCR). The swabs were cultured to isolate the virus. The women were divided into two groups: HHV-6 DNA-positive, and negative. The outcome variables of the infants of these two groups were statistically estimated at birth and at 1 month of age. Saliva and blood cells were collected from the infants at birth and at 1 month of age and were also evaluated by nPCR. HHV-6 DNA was detected in the vaginal swabs of 28 pregnant women (25.5%), but was not detected in any other samples, including saliva and blood cells from their infants. Virus could not be isolated from any vaginal samples. Any outcome variables were not significantly different between the two groups. The presence of HHV-6 DNA within the genital tract of pregnant women did not affect the health of their infants. It is suggested that HHV-6 transmission to infants through the genital tract of their mothers during pregnancy does not occur, or only very rarely.