Double ventricular responses during extrastimulation of atrioventricular nodal reentrant tachycardia

In patients with dual atrioventricular (AV) nodal pathways,double ventricular responses to a single atrial depolarizationhave been shown to occur, but virtually only during a trialpacing in sinus rhythm. We report on a patient with a slow-fastform of AV nodal reentrant tachycardia who exhibited doubleventricular responses following extrastimulation during AV nodalreentrant tachycardia. The phenomenon of double ventricularresponses during the tachycardia was demonstrated by ex trastimulationfrom the proximal coronary sinus. Retrograde unidirectionalblock in the slow pathway, and an anterograde effective refractoryperiod that was shorter in the fast pathway than that in theslow pathway, are suggested.     

External and Skeletal Observations on a New Lethal Mutant of the Rat: Congenital Osteochondrodysplasia with Systemic Subcutaneous Edema

Abstract Malformed rat newborns showing severe subcutaneous edema were frequently found dead in our Wistar-Imamichi rat colony. Their family record suggested that this malformation would be an inherited disorder. Experimental crosses of the phenotypically normal litter-mates revealed that this malformation was a new lethal mutant of the rat, following a single autosomal recessive inheritance. External features and skeletal anomalies of the mutant were carefully checked and compared to those of the phenotypically normal litter-mates. The comparison revealed that (1) this mutant has a characteristic external appearance that includes shortening of the head, trunk, tail and extremities, systemic subcutaneous edema, protruding of the tongue and cleft palate, (2) the axial bones and appendices are shortened and deformed severely and (3) ossification status of the newborn is delayed in digital bones and advanced in the vertebral centra and arches, stemebrae, choracoid process and talus. Observation of the parturition showed that this mutant is born alive but die shortly after birth because of breathing insufficiency. Based on these observations, this mutant was diagnosed as congenital osteochondrodysplasia with systemic subcutaneous edema (ocd for the gene symbol). The mode of inheritance and the similarities to some genetical disorders of other species, including human, are discussed.     

Synthesis and stabilization of amino and carboxy terminal constrained collagenous peptides

Short collagenous peptides cross-linked at their amino and carboxy termini with Lys-Lys-dimer template(s) were synthesized, and the effect of the cross-linking on their stabilities was investigated by thermal denaturation experiments. Two chemoselective ligations were used for the construction of the amino and the carboxy cross-linked peptides. The thermal transition temperature (T_m) and the standard free energies (ΔG°) of the cross-linked collagenous peptides increased, and the thermal stabilization effect corresponded to an elongation by two units of the Gly-Pro-Hyp triad. The van't Hoff enthalpy (ΔH°) and the entropy (ΔS°) values of the cross-linked peptides increased with chain elongation, although the increments were smaller than those of the linear peptides. When the same chain lengths were compared, the ΔH° was increased and the ΔS° was nearly the same or increased by the cross-linking. These results suggest that the cross-linking of the collagenous peptides with the Lys-Lys-dimer template(s) for stabilization contributes to the enthalpic effect, rather than the entropic effect.     

Clinical profiles of autopsy-confirmed dementia with Lewy bodies at institutionalization: Comparison with Alzheimer's disease

Background: It has been reported that Alzheimer’s disease (AD) patients with Lewy pathology have a shorter time from a given baseline to institutionalization than those with AD alone. Taking the clinical distinction between dementia with Lewy bodies (DLB) and AD into consideration, the previous findings may indicate the possibility that the clinical characteristics of DLB patients have an influence on early institutionalization. This study was carried out to clarify whether there are any differences in the symptoms that required institutionalization between patients with DLB and those with AD. Methods: Hospital records and standardized data forms completed at admission to a residential care facility were reviewed to assess the profiles in all cases with autopsy‐confirmed diagnoses for correct differential diagnosis. We examined functional, cognitive and symptomatic conditions at admission to a residential care facility of 18 DLB and 35 AD patients whose diagnoses were confirmed by autopsy. The examinations were conducted using the Gottfries‐Bråne‐Steen (GBS) scale and cognitive tests, and the results were compared between the two groups of patients. Results: Hallucinations, impaired wakefulness, disturbance of ADL and emotional disturbance, common clinical features compatible with DLB, were more frequently observed in DLB patients than in AD patients (P < 0.05). Moreover, DLB patients had higher scores on cognitive tests than did AD patients at admission to a residential care facility (P < 0.05). Conclusion: The distinctive clinical features at admission to a residential care facility may indicate that the reasons for the necessity of institutionalization are different between DLB and AD, and that the interventions specific to DLB patients and their families would be necessary to prevent or postpone institutionalization.     

The Distribution of Helicobacter pylori in Human Gastric Mucosa in vivo

Abstract: To estimate the distribution of Helicobacter pylori in human gastric mucosa in vivo, the phenol red dye spraying endoscopy lias been successfully developed and is performed after an oral and/or intravenous premedication of famotidine 20mg. This technique was conducted on 25 patients with chronic, atrophic gastritis, on 21 patients with a gastric ulcer and on 14 patients with duodenal ulcers. The red color changes which occurred on the gastric mucosa were classified into three types; the diffuse staining type, the regional staining type and the patchy staining type. In the chronic gastritis group, the diffuse staining type, the regional staining type and the patchy staining type occurred in 11 patients (44%), 7 patients (28%) and 2 patients (8%), respectively. The remainder of the patients' mucosa was unstained. In addition, the regional staining type occurred most frequently in the gastric ulcer group, while the diffuse staining type was dominant in the duodenal ulcer group. Notably, a recurrent and intractable ulcer was surrounded by regional staining fields in the stomach, and showed a diffuse staining at the antrum of the duodenum. These facts suggest that Helicobacter pylori prevented ulcer healing. This concurs with the results of our previous experimental study which found that the low concentration NH₃ solution, produced by Helicobacter pylori, prevented an acetic acid ulcer healing in rats and resulted from the suppression of the cell kinetics of the regenerative epithelial cells and the fibroblasts in the connective tissues at the ulcer margins.     

Laparoscopic cholecystectomy in the elderly: Analysis of pre-operative risk factors and postoperative complications

A retrospective study was conducted of two groups of patients over (group 1, n= 57) and under (group 2, n= 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre-operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre-operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra-operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.     

Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.     

Prognostic significance of thrombocytosis in renal cell carcinoma patients

Background: Thrombocytosis has been reported in many types of malignancies and has been studied as a prognostic factor. In the present study, we examined the incidence of thrombocytosis in patients with renal cell carcinoma (RCC) in order to evaluate the prognostic value of thrombocytosis. Methods: One hundred and ninety‐six patients treated by radical nephrectomy for RCC were enrolled in this study. We divided the patients into a normal platelet count group and a thrombocytosis group according to the presurgical platelet count. The two groups were compared pathologically and clinically, including prognosis. Results: Thrombocytosis was present in 16 patients (8.2%). Platelet counts had normalized after nephrectomy in all patients with thrombocytosis. There was no correlation between histological type or grade and thrombocytosis. However, there were correlations between thrombocytosis and tumor size and tumor stage. Patients with thrombocytosis had a worse prognosis than patients without thrombocytosis (P = 0.0028). When adjusted for stage or tumor size, the correlation was limited to low stage (stage 1 + 2: P = 0.0041, stage 3 + 4: P = 0.2983) or small tumors (tumor size: ≤4 cm, P = 0.0021; 4–7 cm, P = 0.0142; >7 cm, P = 0.8158). Conclusion: Thrombocytosis is an inexpensive and easy tool with which to evaluate the prognosis of RCC patients in daily medical practice.     

Renal silica calculi in an infant

We report on a rare case of urinary silica calculi in a 10-month-old boy. The boy showed acute pyelonephritis with left hydronephrosis. Ultrasonography and computed tomography revealed a calculus at the left ureteropelvic junction and three additional calculi in the left renal pelvis. Because his acute pyelonephritis was refractory to conventional chemotherapy, the patient underwent successful left percutaneous nephrostomy followed by percutaneous nephrolithotripsy for the renal calculi. All stones disappeared and his postoperative course was uneventful. On infrared spectrophotometry, the wavelength pattern of the stones exhibited two peaks at 1100 and 1650 cm(-1), consistent with the determination that the calculi consisted of a mixture of silicate (78%) and calcium oxalate (22%). We consider that the etiology of the calculi in this child can be ascribed to the silicate-rich water used to dilute milk. In Japan, 46 adult patients with urinary silicate calculi have been reported in the literature; however, there is no report of the disease in an infant in Japan.