Infective endocarditis and acute purulent pericarditis in a patient with hyperglycemia

A diabetic patient was admitted to our hospital for infective endocarditis with acute purulent pericarditis and diabetic ketoacidosis. Echocardiography revealed attachment of vegetation to the chordae tendineae in the left ventricle and pericaridial effusion. The vegetation was enlarged and pendulated for a few days despite maximal antimicrobial therapy. Surgical resection was desirable to decrease the risk of embolic complications and cardiovascular collapse. We could not open the heart because of accumulation of purulent pericardial fluid, and right renal infarction was complicated. We believe that the immunocompromised and hypercoagulable state due to diabetes caused these conditions.     

Clinical analysis of renoprotective responding patients administrated with oral adsorbent in chronic renal failure secondary to chronic glomerulonephritis

Abstract: An oral adsorbent (AST‐120) that removes uremic toxin has attenuated the progression of renal dysfunction. Although there were decreased serum creatinine (Scr) levels observed during administration, it is expected that the action of an oral adsorbent is different according to the patient. In the present study, the difference in the background was clarified. Methods: A total of 842 patients whose Scr had increased from 3.8 to 4.8 mg/dL during the prior 5.2 months were investigated. Antihypertensive medications and dietary protein intake were unmodified during 6 months administration. The patients were divided into three efficacy groups based on the changes in Scr level; those who had a decrease in Scr were grouped as Group A (N = 290), while those with a <1.5‐fold increase were defined as Group B (N = 428) and those with a ≥1.5‐fold increase were defined as Group C (N = 124). Results: Before administration, these three groups were indistinguishable by the Scr level. No Group A patient went onto dialysis, whereas 12% and 40% of Group B and C patients, respectively, required dialysis. In Group A, the slopes of 1/Scr over time, serum urea nitrogen, uric acid, phosphate, total protein, and diastolic blood pressure were all improved. Group B improved moderately and Group C showed less improvement. Conclusions: In this study, a fairly large number of patients (29% of the population) were believed to be the first case to report the reversibility of severe chronic renal failure. Except in patients with hypoproteinemia, hypercholesterolemia, anemia or hypertension, AST‐120 either attenuates or arrests the progression in patients with severe chronic glomerulonephritis.     

Biochemical and morphological study of cardiac hypertrophy. Effects of thyroxine on enzyme activities in the rat myocardium

Summary Experimental hyperthyroidism induced in rats by daily injections of 3,3,5,5-tetraiode-l-thyroxine (0.5 mg/kg i.p.) for 14 days resulted in a significant increase in heart weight and heart weight/body weight ratio. Hemodynamic and morphological studies were performed in one group. Thyroxine-treated rats showed a characteristic cardiovascular hyperdynamic state, such as tachycardia and augmented rate of contraction, but no evidence of heart failure such as elevated end-diastolic pressures. The cardiac cells in hyperthyroid rats had a significantly larger diameter and more mitochondria than did those of the control rats. In another group the activities of cardiac enzymes involved in energy utilization and liberation were measured biochemically and compared with those of normal controls. Hyperthyroidism resulted in increased specific activity of cytochrome C oxidase and actomyosin ATPase in the myocardium. The specific activity of long-chain acyl-CoA synthetase, carnitine palmityltransferase, carnitine acetyltransferase, malate dehydrogenase and citrate synthase showed a moderate to marked increment, whereas the specific activity of lactate dehydrogenase and pyruvate kinase remained at the control values. These results suggest that in hyperthyroid rat hearts the functions of both energy liberation and utilization systems are enhanced to meet the added workload. Moreover, the increased activity of the enzymes participating in fatty acid metabolism suggest that in thyroxine-induced hypertrophic and hyperdynamic rat hearts, fatty acids contribute more to the energy supply than do carbohydrates.This study was supported in part by a grant-in-aid for scientific research from the Ministry of Education, Science and Culture of the Japanese Government.     

A case of systemic sclerosis sine scleroderma associated with perforation of an afferent loop after subtotal gastrectomy with Billroth 2 anastomosis for its severe gastrointestinal involvement

A 50-year-old man was admitted to hospital for dysphagia. The upper gastrointestinal series revealed esophageal stricture, pyloric stenosis, and hypomotile small intestine. He was diagnosed with systemic sclerosis sine scleroderma with gastrointestinal involvement. After subtotal gastrectomy with Billroth 2 anastomosis, he had recurrent intestinal pseudo-obstruction and perforation of the afferent loop. Our experience indicates that surgical procedures in bowel scleroderma, in which an afferent loop is reconstructed, could easily cause perforation of the afferent loop.     

Unusual variant of left paraduodenal hernia herniated into the mesocolic fossa leading to jejunal strangulation

Paraduodenal hernia is a rare condition in which the small bowel loops are herniated into an unusual fossa in the periduodenal area. We treated a patient with paraduodenal hernia diagnosed pre-operatively. A 28-year-old woman was admitted to our hospital because of intermittent abdominal pain. Abdominal ultrasonography revealed a large tumor adjacent to the pancreas. Provisional diagnosis made according to computed tomography (CT) findings was tumor of the pancreas tail. However, on a CT scan performed after the administration of diatrizoate meglumine/diatrizoate sodium (Gastrografin, Schering, Berlin, Germany) the mass was shown as a jejunum loop located between the stomach and the pancreas body. Subsequent laparotomy revealed that the jejunum loop was herniated into an unusually large mesocolic fossa and that the hernial orifice was covered by the adhesion between the transverse and descending colons. It seemed that the small intestine within the mesocolic fossa was strangulated by this adhesion. The patient's abdominal pain resolved postoperatively. These observations suggest that paraduodenal hernia should be suspected in patients with chronic, atypical abdominal pain, regardless of the findings for small bowel obstruction. (Received Oct. 6, 1997; accepted Jan. 23, 1998)     

Minimally invasive transanal surgery for localized rectal carcinoid tumors

Local excision is often fully justified for rectal carcinoid tumors. However insufficient surgical field and difficult access to proximal tumors have been drawbacks in performing pre-existing local excision procedures. A novel local excisional technique called minimally invasive transanal surgery (MITAS) has been experimented for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder was used and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. Eight patients with carcinoid tumors in the rectum (4 tumors in the upper rectum) underwent MITAS. Median distance from anal verge to proximal tumor was 6.5 cm (range, 5–12 cm). The median diameter of the tumor was 9 mm. Median operative time was 18.5 minutes and blood loss was minimal. No analgesics were needed postoperatively, and there was no morbidity or mortality. Full-thickness excision of the rectum was accomplished and the tumors confined in the submucosa were demonstrated histologically to be with free surgical margins. No recurrences have been observed with a median follow-up period of 39 months. The technique facilitates total excisional biopsy for rectal carcinoid tumors and reduces operative time, blood loss and complications. Received: 10 January 2002 / Accepted in revised form: 28 January 2002     

Cavernous hemangioma of the liver with giant cyst formation: Degeneration by apoptosis?

Cavernous hemangioma of the liver with cyst formation is a very rare condition. A case of cavernous hemangioma of the liver with unilocular giant cyst formation undergoing surgical removal is reported. Notably, the patient also had Budd-Chiari syndrome with an obstructing lesion in the inferior vena cava. The cystic degeneration of the hemangioma implied a relationship with apoptosis. This is the first reported case of Budd-Chiari syndrome caused by advanced cystic degeneration of hepatic cavernous hemangioma.