Blood flow in the operating field during controlled hypotension by nitroglycerin, trimetaphan and prostaglandin E1

We used the laser flowmeter to measure and compare the effect of nitroglycerin (TNG), trimetaphan (TMP) and prostaglandin E1 (PGE1) on the blood flow of operating field during hypotension induced by each drug. The study was done in 33 patients (TNG:13, TMP:13 and PGE1:7) anesthetized with modified NLA who underwent radical mastectomy. We put the probe of the laser flowmeter on the skin of the opposite breast to the operating field and measured the skin blood flow change. Measurements were made before and during hypotension induced by each drug. TMP-induced hypotension decreased blood flow significantly (P less than 0.05), but TNG and PGE1 had no significant effect. Intraoperative blood losses of TNG and PGE1 group were not significantly larger than that of TMP group. From this study we conclude that TNG, TMP and PGE1 can dry the operating field and decrease intraoperative blood loss similarly. Therefore we should choose the drugs to induce hypotension considering the effect of the drug on blood flow of the important organs and each patient's complications.     

Glossopharyngeal neurinoma causing symptomatic hemorrhage: case report

A 86-year-old man was admitted to our hospital because of swallowing disturbance and deterioration of consciousness. He had been aware of hearing disturbance on the right side for twelve months. Computed tomography (CT) scan demonstrated an inhomogeneous hyperdense mass lesion, 3.2 X 2.3 cm in size, at the right cerebello-pontine angle, and ventricular enlargement with intraventricular hemorrhage. Skull tomogram revealed destructive enlargement of the right jugular foramen. The angiogram showed avascular mass with elevation of anterior inferior cerebellar artery, and downward shift of posterior inferior cerebellar artery. Operative and histological findings were compatible with glossopharyngeal neurinoma of Antoni type A dominance. This tumor had numerous abnormal vessels probably causing massive hemorrhage. Only fifteen cases of intracranial neurinoma with symptomatic hemorrhage have been reported in the world literature. This case is reported as the sixteenth one and the first glossopharyngeal neurinoma among them. Possible etiology of such hemorrhage is discussed.     

An experimental and clinical study of energy-protein metabolism and host defense-repair mechanism in postoperative period--a significance of administration of branched chain amino acid

The aim of this study is to evaluate in vivo the effect of branched chain amino acid (BCAA). Experimentally, hepatic energy production and protein synthetic rate were measured in gastrectomized rat which was infused BCAA postoperatively. Clinically, following indices were examined in prospectively randomized patients who underwent abdominal operation and were administered with conventional total parenteral nutrition keeping Calorie/N ratio about 150, including nitrogen balance, urinary 3-methylhistidine, retinol binding protein, B lymphocyte percentage and lymphocyte blastogenesis by phytohemagglutinin. Furthermore, plasma BCAA with their keto-analog level, Factor XIII and opsonic activity were determined in another group of patients who received full strength load of BCAA immediately after subtotal or total gastrectomy, in a controlled prospective randomized double-blinded manner. Results obtained from above mentioned measurements exhibited significant improvement by the administration of BCAA. From these findings, it is suggested that BCAA sustains energy-protein metabolism, supports immunocompetence and promotes wound healing under moderately stressed condition where catabolic response is physiologically compensated.     

Liquid crystal thermography; a reliable method for detecting soda lime exhaustion

The dynamic and functional state of soda lime can be more precisely assessed by measuring changes in wall temperatures of the absorption chambers rather than observing color change of the soda lime granules. We demonstrated in this report that the liquid crystal thermometer is an inexpensive and reliable measuring device for this purpose.     

Asymptomatic autoimmune chronic active hepatitis in a male adolescent

We report a 12-year-old boy presenting with smooth muscle antibody-positive auto-immune chronic active hepatitis. Suspicion of the diagnosis arose after a routine blood test which revealed abnormal liver function tests. In spite of the presence of cirrhosis and patchy necrosis on liver biopsy, our patient never showed any clinical feature of impaired liver function. This observation demonstrates that auto-immune hepatitis may exist for a long time before clinical symptoms appear and probably explains why some cases of auto-immune hepatitis finally present as fulminant liver failure.     

Primary repair of tetralogy of Fallot in infancy

From June 1983 to April 1988, 100 consecutive infants with symptomatic tetralogy of Fallot (without pulmonary atresia) were operated on. Ages ranged from 0.5 to 12 months (mean 7.3 +/- 3.7). Twenty patients were 0.5 to 3 months, 21 were 3 to 6 months, and 59 were 6 to 12 months of age. Mean weight was 6.5 kg +/- 1.7. Seventy patients received a transannular patch. The hospital mortality rate was 3% and there were no late deaths. Cumulative follow-up was 180 patient-years. Causes of death included hypoplastic pulmonary arteries (4 and 5 months old) and right ventricular failure (4 months old). The most important factors influencing right ventricular outflow tract reconstruction were neither weight (p = 0.90) nor age (p = 0.05) but rather were the ratio between weight and pulmonary arterial outflow tract diameter (p = 0.0005) and the ratio between body surface area and pulmonary arterial outflow tract diameter (p less than 0.0001). The last 48 patients were operated on with no deaths. During this period, operative management differed essentially in myocardial protection with blood cardioplegia. The predicted 30-day survivorship after repair was 90% to 99% (95% confidence limits). No ventricular arrhythmias have been detected after repair (mean follow-up 22.2 months). Mean right ventricular/left ventricular end-diastolic dimension ratio was (0.53 +/- 0.10 with M-mode echocardiography. These early results encourage us to proceed with primary repair of infants with symptomatic tetralogy of Fallot thanks to improved surgical management and enhanced myocardial protection.     

Epidermoid cyst (monodermal teratoma) of the testis

We report 14 patients with epidermoid cyst of the testis (monodermal teratoma). In 7 patients (5 treated within the last 5 years) the mass was excised and adjacent testicular tissue was biopsied. Seven patients underwent radical inguinal orchiectomy. Carcinoma in situ was not detected in any testicular tissue examined. There was no evidence of tumour recurrence in any patient after a mean follow-up of 10 years. Ultrasonographic appearance was not specific for a diagnosis of epidermoid cyst and exploratory surgery was required in all cases. Excision of the tumour and biopsy of adjacent testicular tissue to determine the presence or absence of carcinoma in situ is adequate treatment for this rare testicular neoplasm.     

A case of secondary bladder tumor the origin (gastric cancer) of which could not be identified before autopsy

Primary bladder tumor is the most frequent malignant tumor in the field of urology, whereas the incidence of secondary bladder tumor from a distant organ is quite rare. We report here a 21-year-old female patient with metastatic bladder tumor from gastric cancer. She came to our hospital with a complaint of only bladder irritability. Cystoscopical and cytological examinations revealed rhabdomyosarcoma of the bladder. She did not respond to radiation therapy and combined chemotherapy, consisting of actinomycin D, vincristine and cyclophosphamide, and died 91 days after admission. Autopsy revealed a primary tumor of poorly differentiated scirrhus carcinoma of the stomach. Thus this was a quite rare case of metastatic bladder carcinoma characterized by bladder irritability without gastrointestinal symptoms.     

Immediate elimination of labile HbA1c with allosteric effectors of hemoglobin

Our aim was to find a simple method of removing labile glycosylated hemoglobin (HbA1c) from blood samples before it is measured by cation-exchange chromatography. Labile HbA1c is formed by the binding of glucose to the NH2-terminal valine of the beta-chain of HbA. We sought a more competitive binder for the same site to dissociate labile HbA1c to glucose and HbA. Inorganic phosphates were found to have a strong allosteric effect and a great ability to eliminate labile HbA1c. We developed our method with 4 mM tetrapolyphosphate in the hemolyzing solution to eliminate labile HbA1c during the automatic processing (at pH 6 and heated for 2 min at 45 degrees C) of blood samples for HbA1c estimation. This may be useful when estimating HbA1c by the manual method.