Congenital malignant melanoma

A case is reported of congenital malignant melanoma that occurred in the absence of maternal melanoma or a congenital giant naevus. The patient had the melanoma on the left thigh excised 54 days after birth, but later died at the age of 18 months with multiple metastases.     

Effect of drinking on the outcome of cirrhosis in patients with hepatitis B or C

Survival rates were calculated for 251 patients with cirrhosis of the liver but without hepatocellular carcinoma, primary biliary cirrhosis, or autoimmune cirrhosis who underwent laparoscopy during the past 21 years at the authors' hospital. The survival rates were calculated by the Kaplan-Meier method. Stored serum was assayed for hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis C virus (HCV). Patients with alcoholic cirrhosis had significantly better survival rates than patients with HBsAg, HCV, or both. Differences in survival rates between patients with hepatitis B and C were insignificant. In both groups, habitual drinkers had a significantly lower survival rate. The results suggested that alcohol accelerates liver damage in subjects with viral hepatitis.     

I.v. compared with brachial plexus infusion of butorphanol for postoperative analgesia

In a randomized, double-blind, controlled study, we have comparedtwo groups of patients receiving either continuous systemici.v. or continuous brachial plexus infusion of butorphanol foran algesia after operations on the upper extremities. Twenty-twopatients undergoing elective upper extremity surgery were allocatedrandomly to one of two groups to receive either butorphanoli.v. and saline injected into the brachial plexus sheath (i.v.group) or butorphanol injected into the brachial plexus sheathand saline i.v. (brachial plexus group). After surgery on theupper extremity under continuous axillary brachial plexus block,each patient received a continuous infusion of butor phanoleither i.v. or into the brachial plexus sheath at a dose of83.3 µg h^–1. Concurrently, a saline infusion wasgiven via the alternate route. Patients rated their pain ona 10-cm visual analogue scale (VAS). VAS scores in the two groupsdid not differ up to 6 h and 24 h after operation. From 9 huntil 24 h after operation, pain scores were significantly higherin the i.v. group than in the brachial plexus group. The VASscore 9 h after operation was 3.3 (SD 2.7) in the i.v. groupand 0.6 (0.9) in the brachial plexus group (P < 0.01); 12h after operation 2.7 (1 .8) in the i.v. group and 0.6 (0.9)in the brachial plexus group (P < 0.01); 18 h after operation1 .7 (1.0) in the i.v. group and 0.7 (1.0) in the brachial plexusgroup (P < 0.05); and 24 h after operation 3.2 (2.4) in thei.v. group and 0.7 (1.2) in the brachial plexus group (P <0.01). We conclude that continuous injection of butorphanolinto the brachial plexus sheath provided superior analgesiacompared with continuous i.v. injection.     

Treatment for inpatients with anorexia nervosa: Comparison of liquid formula with regular meals for improvement from emaciation

Abstract A new refeeding program using only liquid formula was given to six anorexic inpatients (LF group) at the initial stage of hospitalization. These patients were compared with six other inpatients who regular meals (RM group). The LF group did not develop a phobia of gaining weight, while the RM group showed a vicious cycle of gastrointestinal discomforts leading to fat phobia and stagnation in weight gain. By comparison, the LF group had fewer gastrointestinal symptoms, which resulted in the disruption of this cycle and seemed to help motivate these patients to obtain a steady gain in bodyweight.     

A New Method for Measurement of Gastric and Colonic Lesions with an Electronic Endoscope and Image Processor

In order to measure the sizes of gastric and colonic lesions endoscopically, we established a system composed of an electronic endoscope, image processor, and personal computer. The long and short diameter of the lesion were calculated by a program which corrected the curvature radius of the lens of the endoscope and variables. 1) To evaluate its accuracy, we measured a 10 mm scale spherical model at different distances from the lens of the endoscope. The mean value was 9.7 mm, ranging from 9.0 to 10.9 mm. The rate of error was –0.38±4.4 % (mean±SE). 2) Using this system, we measured the sizes of 34 gastric and colonic lesions in 34 patients (3 with gastric cancers, 20 with gastric polyps, and 11 with colonic polyps), and compared them with the real sizes of the resected or polypectomized specimens. The rate of error was–1.1±1.3% (mean±SE). The results showed that our system was useful to evaluate the accurate sizes of gastric and colonic lesions endoscopically.     

An Endoscopically Resected Case of Early Carcinoma of the Duodenal Bulb

We report here on a case of early carcinoma originating in the duodenal bulb. The patient was a 70-year-old woman who complained of nausea. A gastrointestinal endoscopy disclosed a lesion protruding from the duodenal bulb and a biopsy revealed adenocarcinoma. According to the results of the endoscopy, the tumor was subpedunculated and probably confined in the mucosal layer. Based on these findings, we performed an endoscopic tumor resection. A histological examination of the resected specimen revealed a papillotubular adenocarcinoma (1.7 × 1.2 × 0.8 cm) localized in the mucosal layer. No carcinomatous lesion was left in the resected margin. No symptoms of recurrence have been noted during the last 6 months. When considering clinical pathology of the present case, we assessed 39 cases of primary early carcinoma in the duodenal bulb previously reported in the Japanese literature. We considered that our patient was the 14th in Japan with an early carcinoma of the duodenum which was completely excised via endoscopic resection. We expect that endoscopic resection of early duodenal carcinoma will be widely used in the future.     

Age of Onset and Progress by Ageing in High Myopia

Abstract The amount of refractive errors, visual acuity, fundus findings, age of onset and other relevant data were examined in 614 cases of myopia, at the Department of Ophthalmology in Juntendo University.
Twenty-seven per cent (27/100 cases) among high myopia (-15.0D ± 7.5D) with typical chorio-retinal atrophy and 20% (55/275 cases) of myopia (-12.7D ± 6.4D) without typical myopic atrophy had onset at 4 yrs old or younger. However, there was no case whose age of onset was 4 yrs old or younger among 239 cases of myopia with 5D or weaker. All of them had onset in 7 yrs old or older.
The average corrected visual acuity became worse as the patient became older, especially in 'high myopia with chorio-retinal atrophy, it was (0.4-0.5 already in childhood and about 0.2 in 40 yrs old or older). However, the corrected visual acuity in high myopia without typical myopic atrophy was kept comparatively good (about 0.7 in 40s or younger and 0.4 in 60s or older). Degree of myopia increased significantly by age, but stopped at around the 40s. These facts show that early age of onset of high myopia is very important.     

Morphological Variation of Nonreentrant Idiopathic Ventricular Tachycardia Originating from the Right Ventricular Outflow Tract and Effect of Radiofrequency Lesion

RF catheter ablation was performed in 16 patients with nonreentrant idiopathic VT originating from the RVOT. All documented VT was monomorphic, but subtle morphological variation in the VT-QRS complex was observed in 10 (63%) of 16 patients. Through endocardial mapping, VT origin was determined within a narrow site (< 0.5 ± 0.5 cm) in 4 of the 10 patients with the morphological variation. In the other 6 of 10 patients, the origin extended to an area of > 0.5 ± 0.5 cm. In VT with morphological variation, the local electrogram at the site of VT origin also showed variation in morphology and activation sequence. For VT of narrow origin, RF application to the site eliminated the VT. However, in VT from a wide arrhythmogenic area, RF current had to be delivered to 3–7 distinct sites to cover the possible origin, and specific QRS configuration of VT and/or PVC was ablated at each of the earliest activation site. All but one VT were successfully ablated by RF current. Subtle morphological variation was frequent in this type of VT, and about half were associated with a wide arrhythmogenic area. Precise mapping and analysis of the efficacy of each BF application might be helpful to better understand the relationship between subtle changes of VT-QRS morphology and their origins.     

Circular dichroism investigations on the conformation of linear,cyclic and polymeric peptides containing His,Ser and Asp residues

Conformational studies on the linear, cyclic and polymeric peptides with the sequences -Asp-ßAla-Gly-Ser-ßAla-Gly-His-ßAla-Gly-(nonapeptide series) and -Asp-eAhx-Ser-eAhx-His-eAhx (hexapeptide series) were carried out by means of circular dichroism measurements to clarify the relationship between their conformation and ester hydrolytic activity. It was suggested that all of the present peptides take a certain ordered conformation at acidic pH region and have a tendency to transform to a disordered conformation with a rise of pH. In the course of the conformational change, the linear and polymeric peptides undergo a drastic conformational change at around pH 7.0, while the cyclic peptides maintain the ordered conformation to some extent even at the basic pH region. Although this ordered conformation maintained in the cyclic peptides was estimated not to be a tight one, it was more stable in the cyclic peptide of the latter sequence (Cyclic-6) than in the former sequence (Cyclic-9). As reported previously, Cyclic-6 showed greater activity than the others in the hydrolysis of various ester substrates. Higher activity and more stable ordered conformation of Cyclic-6 seem to be closely related. The effects of urea, organic solvent, salt and change of temperature on their conformation are also reported.