Inner ear barotrauma: computed tomographic evaluation

Eight patients with inner ear barotrauma were evaluated by computed tomography. The causes of the inner ear barotrauma were diving in four, flying in an airplane in three, and climbing in one. Regarding the width of the cochlear aqueduct, no significant difference was observed between the affected side (3.28 ± 0.49 mm) and non-affected side (3.63 ± 0.79 mm) at the base of the infundibulum. The jugular fossa could not be identified on the affected side in three patients. Some relationship may exist between inner ear barotrauma and poor development of the jugular fossa.     

Relationships between the Hepatic Intrinsic Clearance or Blood Cell-Plasma Partition Coefficient in the Rabbit and the Lipophilicity of Basic Drugs

The relationships between drug lipophilicity and hepatic intrinsic clearance (CL_int,h) or red blood cell-plasma partition coefficients (D) have been elucidated for ten highly lipophilic basic drugs with apparent octanol-water partition coefficients at pH 7.4 (P_{app, oct}) of 150 or above. The true octanol-water partition coefficients of the non-ionized drugs (P_oct) were used to determine CL_int,h and D for the unbound drugs (CL_int,h,f and D_f, respectively), and CL_int,h,f and D_f for the non-ionized and unbound drugs (CL_int,h,fu and D_fu, respectively). The total clearance values were determined at steady state by infusion studies of individual drugs in rabbits. There was better correlation between log P_oct, and log CL_int,h,fu (r = 0.974) than between log P_oct, and log CL_int,h,f (r = 0.864). The D values were calculated from the blood-plasma concentration ratio. There was a better correlation between log P_oct and log D_fu (r = 0.944) than between log P_oct, and log D_f (r = 0.612). The regression equations obtained were CL_int,h,fu = 0.0875 × P_oct^1.338 and D_fu = 0.0108 × P_oct^0.970, respectively. These results show that the CL_int,h and D of highly lipophilic basic drugs can be predicted from P_oct by taking f_u into consideration. By applying these parameters to a physiologically based pharmacokinetic model it might be possible to predict the pharmacokinetics of unknown basic drugs.     

Value of pathological grading in prediction of renal survival in IgA nephropathy

Summary: In order to clarify the most reliable risk factor to predict renal outcome, 206 patients with IgA nephropathy were studied for mean period of 9.2 years. the histopathological changes of this disease using light microscopy were divided into four grades (grade 1–4). These grades included glomerular, interstitial and vascular lesions. the cumulative rate of kidney survival progressing to end stage renal failure (ESRF) in all patients was 94% at 5 years, 87% at 10 years and 80% at 15 years after renal biopsy. None of the patients in grade 1 reached ESRF. the cumulative rate of kidney survival in grade 2 was 99% at 5 years, 98% at 10 years and 89% at 15 years after renal biopsy. In grade 3, it was 94% at 5 years, 79% at 10 years and 75% at 15 years. In grade 4 it was 53% at 5 years, 33% at 10 years and 22% at 15 years after renal biopsy. Forward stepwise multivariate regression analysis revealed that, in addition to the histopathological findings, three more risk factors were found to influence actuarial renal survival rate. These factors were: (i) the levels of serum creatinine; (ii) the level of serum albumin; and (iii) the amount of proteinuria at the time of renal biopsy. In parallel studies, forward stepwise multivariate regression analysis isolated three risk factors that influenced the progression of the reciprocal of serum creatinine. These factors were: (i) the levels of total protein; (ii) the degree of our pathological grading; and (iii) the amount of proteinuria. It was concluded that our pathological grading was useful as a prognostic parameter because of its simplicity and availability in routine clinical activities.     

Oral contraceptive-dependent growth of focal nodular hyperplasia

Abstract A 22 year old woman was incidentally found to have a hepatic small haemangioma-like mass, measuring 1.4 cm in diameter, by an ultrasonographic examination. The mass demonstrated no change in size or appearance for 6 months until the patient began to take oral contraceptives. Eventually, the mass increased to 2.0 cm in diameter after using oral contraceptives for 6 months. A histological examination suggested the mass to be typical focal nodular hyperplasia, and not hepatic adenoma. There was no further change in either size or appearance in the ensuing 1 year after the discontinuation of oral contraceptives.     

Effects of biofeedback training on tonic masticatory neck reflex: a case report

Biofeedback training to reduce muscle tension lowered not only the spontaneous activity but also the tonic neck reflex in the jaw closing muscles. Tolperisone-HCL, which may inhibit the gamma system, inhibited the tonic masticatory neck reflex, but did not reduce the patient's spontaneous activity of the jaw closing muscles in this case. Biofeedback training may be considered to reduce the gamma as well as alpha motor systems.     

Case report: Lymphangioma of the oesophagus endoscopically resected

Lymphangioma of the oesophagus is an extremely rare entity, with only nine cases having been reported worldwide. We report on a 52-year-old woman with oesophageal lymphangioma, diagnosed using endoscopic ultrasonography and endoscopically resected. No case of malignant transformation of the lymphangioma has been reported in the literature. Endoscopic resection seems to be a minimally invasive method that is appropriate both for the removal of the tumour and precise diagnosis.     

Maximum tumor diameter is a simple and valuable index associated with the local extent of disease in clinically localized prostate cancer

BACKGROUND: The present study was undertaken to investigate the association of pathological features, including the total tumor volume (TTV), maximum tumor area (MTA), and maximum tumor diameter (MTD), with the local extent of disease in clinically localized prostate cancer. METHODS: Serial whole sections of the prostate from 164 patients who underwent radical prostatectomy for localized prostate cancer were investigated. The correlations between the indicators of tumor size, including the TTV, MTA, and MTD, and other pathological parameters were evaluated. RESULTS: The MTD, MTA, and TTV were significantly correlated with each other. Multivariate stepwise logistic regression analysis indicated that the Gleason score, perineural invasion, microvascular invasion, and MTD were significant independent parameters associated with extraprostatic disease. CONCLUSION: The histological tumor grade, perineural invasion, microvascular invasion, and tumor size were correlated with the local extent of disease. The MTD, a simple, easy, and inexpensive parameter, is a more significant pathological feature associated with the local extent of disease than the MTA or TTV.     

Plasma Catecholamines and Cyclic AMP Response During Head-Up Tilt Test in Patients with Neurocardiogenic (Vasodepressor) Syncope

To examine hemodynamic, plasma Catecholamines, and cyclic AMP changes during tilt in patients with neurocardiogenic (vasodepressor) syncope, six patients underwent 80± head-up tilt test for 10 minutes with isoproterenol infusion (1–3 μg/min). Venous blood was sampled in the supine position, at 3 minutes of tilt, and at the onset of vasodepressor reaction during tilt. AH patients had previous tilt studies in which vasodepressor syncope had been induced reproducibly (mean 3.3 episodes in each patient). Syncope was induced at 6.1 ± 0.4 minutes of tilt with an infusion of isoproterenol (mean 1.7 ± 0.3 fig/min). Although arterial pressure and heart rate did not change significantly between in the supine position and at 3 minutes of tilt, plasma norepinephrine increased significantly at 3 minutes of tilt (0.44 ± 0.10 ng/mL; P < 0.05) and at the onset of vasodepressor reaction (0.49 ± 0.12 ng/mL; P < 0.01) compared to the supine position with isoproterenol (0.34 ±0.10 ng/mL). Also, cyclic AMP (cAMP) increased significantly at 3 minutes of tilt (25.3 ± 2.0 pmol/mL; P < 0.005) and at the onset of vasodepressor reaction (29.6 ±1.7 pmol/mL; P < 0.005) compared to the supine position with isoproterenol (20.4 ±1.9 pmol/mL). After administration of selective beta₁-blocker, metoprolol (40 mg/day), plasma norepinephrine, and cAMP during tilt did not change significantly compared to baseline tilt. However, metoprolol prevented the syncope in 3 of 6 patients. After administration of beta₁-, beta₂- blocker, propranolol (30 mg/day), cAMP at 3 minutes of tilt decreased significantly compared to the baseline tilt (16.9 ±1.4 pmol/mL vs 25.3 ± 2.0 pmol/mL; P < 0.05) and propranolol prevented the syncope in all six patients. We concluded that the increase of cAMP may play an important role for the induction of vasodepressor reaction in patients with neurocardiogenic (vasodepressor) syncope. The concentration ofcAMP showed more sensitive response to vasodepressor reaction than that of norepinephrine.