Beneficial effects of intracoronary nicardipine on hypoxic myocardium

Regional effects of intracoronary administration of nicardipine, a dihydropyridine derivative with calcium blocking activity, were studied in 13 open-chest dogs. Hypoxic, constant-flow perfusion was done in the area supplied by the distal left anterior descending artery. The 5-min regional hypoxic perfusion did not result in significant alterations in either heart rate or aortic pressure in 6 control dogs perfused with original Krebs-Henseleit solution (KHS), which was deoxygenized by mixed gas (95%N2 and 5%CO2), and in 7 dogs perfused with nicardipine-containing (0.2 mg/dl) KHS. A transmural biopsy after 5 min of perfusion revealed a less severe metabolic deterioration in nicardipine-treated dogs than in control dogs, as indicated by a higher ATP content (2.84 +/- 0.43 vs. 2.23 +/- 0.45 mumol/g, wet weight). The sequence of regional contractile deterioration was not different between the 2 groups. In conclusion, regional nicardipine administration showed a myocardial protective effect which was not mediated by afterload reduction in the whole heart.     

Bone marrow transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

We reported the results of 6 allogenic bone marrow transplantation (BMT) and 3 autologous BMT for patients with Philadelphia chromosome (Ph1)-positive acute lymphoblastic leukemia (ALL) by Nagoya BMT group. Two of six patients who received allogenic BMT have continued complete remission (CR) on +639 days and +1,597 days. Four of six patients relapsed on +134, +203, +216, and +267 days. Two patients with a disease-free survival for a long time had both acute and chronic GVHD. It is suggested that graft-versus-leukemia (GVL) effect might prevent the relapse. On the contrary, one patient who received with monoclonal antibodies plus complement-treated autologous bone marrow is free of leukemia on +439 days. Our results suggest the follows. 1) We do chromosomal analysis at initial diagnosis in all cases to do BMT in first CR. 2) We intensify the conditioning regimen for BMT. 3) We study on application of GVL effect to prevent the relapse. 4) We establish the best purging method to eradicate residual leukemic cells for autologous BMT. 5) We do allogenic BMT using HLA-matched unrelated donor for patients without related donor.     

Repeated transsphenoidal surgery for pituitary adenomas

It is well known that the risks in patients subjected to repeated transsphenoidal surgery are higher than in patients without prior therapy. The authors report their experience of repeated transsphenoidal surgery in 18 pituitary adenoma cases, 7 as the second step of two staged operation, 7 for recurrent adenomas and 4 for the postoperative CSF rhinorrhea. Technical points in re-opening and closure of the transsphenoidal route are presented. A huge adenoma with suprasellar extension may be successfully removed by two staged operation. Some adenomas become less hemorrhagic at the second operation. Recurrent adenomas are also safely operated when the goal of the surgery is limited to the decompression of the optic nerve with sparing the pituitary function. CSF rhinorrhea is easily controlled by packing the sella turcica and the sphenoid sinus with one piece of fat for each compartment.     

Dementia and disturbance of consciousness in thalamic degeneration

A 53-year-old male with thalamic degeneration is presented. He had double vision, cerebellar signs, and pyramidal and extrapyramidal tracts signs in addition to hypersomnia, decrease in spontaneity and attention, and impairment of memory as psychic symptoms. These signs and symptoms were progressive, and he subsequently developed akinetic mutism and died of pneumonia 17 months after the onset of the disease. His clinical diagnosis was considered as Gerstmann-Str?ussler syndrome due to progressive dementia, cerebellar signs and the other signs mentioned above. The postmortem pathological investigations, however, revealed thalamic degeneration. The pathological observations showed marked loss of nerve cells and glial proliferation in the medial and anterior nuclei of thalamus. The same pathological changes were more or less demonstrated in the pulvinar, the periaqueductal gray matter of midbrain, inferior olivary nucleus, the medial parts of globus pallidus, the substantia nigra and the dentate nucleus. In the early stage of the clinical course, it was difficult to know whether the main symptoms were caused by dementia or by the disturbance of consciousness. Retrospective considerations, however, showed that dementia had appeared at first, and subsequently the disturbance of consciousness had joined. As the result, it seems that they finally caused akinetic mutism. It is known as thalamic dementia that in the cerebrovascular disease the lesions in the medial and anterior parts of bilateral non-specific thalamic nuclei cause dementia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance imaging (MRI) in the diagnosis of optic neuritis and neuropathy

Magnetic resonance imaging (MRI) was performed in thirty patients who had been suffering from optic neuritis (ON). Twenty-one cases were caused by multiple sclerosis (MS) and in 9 cases the causes been defined. In MRI, abnormalities were found in 17 out of 21 MS cases in several places such as near the ventricles, mid-brain, spinal cord etc. Increased signals from the optic chiasm to optic radiation were found in 5 cases. However, abnormal MRI findings did not always correspond to Goldmann visual field defects. In 3 out of 9 cases of ON with unknown causes, high signals in the white matter of the brain were found, and it was suggested that those may develop to MS. MRI was, thus, proved to be very useful for the diagnosis of MS.     

Omental bleeding with spontaneously derotated torsion

A case of omental torsion seen in a 16 year old male is reported herein. Abdominal pain in the right lower quadrant suddenly developed just after the patient twisted his waist and an emergency laparotomy revealed a hemorrhagic mass at the edge of the right omentum, which was excised. Histological examination of the resected specimen showed hemorrhage without any venous thrombosis or infarction, possibly suggestive of omental torsion with early spontaneous derotation. The patient was successfully treated as a case of omental torsion.     

A case of successful resection of pulmonary arteriovenous fistula with a high shunt ratio

We report on a 25-year-old cyanotic man who was diagnosed as having a pulmonary arteriovenous fistula. His chief complaint had been shortness of breath since childhood. Polycythemia (Hb 21.4 g/dl) was detected during a health checkup at his company. A chest X-ray showed an abnormal mass in the left lung. Blood gas analysis showed severe hypoxia with PaO₂ of 38.6 mmHg at room air. Angio-CT showed a large aneurysmal lesion at S6 of the left lung with a large feeding artery and vein. Oxygen saturation was 75.2% in the radial artery and 62.5% in the right atrium. The right-to-left shunt ratio was therefore calculated as 62%. The aneurysmal lesion was resected by segmentectomy of the left S6 following division of A6 and V6. After a successful operation, the patient no longer had shortness of breath or cyanosis and blood gas analysis showed PaO₂ as 84.3 mmHg at room air. Pulmonary angiography showed no residual shunt lesion.