Multiple fistulae of coronary arteries to both ventricles

A 74 year old man was found at necropsy to have multiple coronary arteriosystemic fistulae involving all three major coronary arteries and both ventricles. This is the second such case reported. All terminal branches of the coronary arteries entered the myocardium and numerous tiny vessels opened into the cardiac chambers. No coronary veins or coronary sinus were recognized. This vascular anomaly is considered to result from the abnormal persistence of intertrabecular spaces within the embryonic myocardium.     

Simplified central bisegmentectomy for liver cancer

The close relationship of the two central (medial and anterior) segments of the liver to the right, middle, and left hepatic veins and to the inferior vena cava makes hepatic resection in this region extremely difficult. A method of resection that is safe and reliable is desirable. Nine patients underwent central bisegmentectomy by a simplified procedure based on the principle of ligation of vascular and biliary structures as a unit within a sheath. Central bisegmentectomy was carried out, with ligation and division of the anterior sheath pedicle from the hepatic hilus and of medial sheath pedicles from the umbilical plate before liver parenchymal dissection. Surgery (lasting from 4 h 10 min to 7 h 40min) was safely performed in all nine patients. Blood loss during surgery ranged from 571 to 4890 ml. Blood loss was significantly greater in patients with tumors in contact with the inferior vena cava and hepatic veins than in the other patients. Postoperative bile fistula occurred in one patient, and the morbidity rate was 11%. There was no hospital mortality. The method of central bisegmentectomy described here is a simple and reliable technique without serious side effects.     

Human erythrocyte polyamine levels after portal vein embolization

BACKGROUND/AIMS: Polyamine levels in erythrocytes are related to liver regeneration and could be used as an index of liver regeneration after partial hepatectomy. We investigated liver regeneration after portal vein embolization according to the changes of erythrocyte polyamine levels. METHODOLOGY: Levels of polyamines (putrescine, spermidine, and spermine) in erythrocytes were assayed by high-pressure liquid chromatography for 13 patients with hepatocellular carcinoma after portal vein embolization and 16 patients (8 from group reported earlier) after right bisegmentectomy of the liver for hepatocellular carcinoma. In the first group, embolization preceded surgery by 3 weeks. RESULTS: The mean total polyamine level in erythrocytes and the levels of spermidine and spermine were significantly higher at day 7 after embolization, decreasing later. Spermidine and spermine increased by day 7 after partial hepatectomy, decreasing later. Their mean increase was smaller and more gradual when embolization was done before resection than without embolization. CONCLUSIONS: Embolization causes regeneration of the non-embolized portion of the liver, and embolization before liver resection allows regenerative activities of the liver remaining after resection to be lower than without the embolization.     

Prevalence of functional dyspepsia and its relationship with Helicobacter pylori infection in a Japanese population

AIM: To investigate the prevalence of functional dyspepsia and Helicobacter pylori infection and their relationship in a Japanese population. METHODS: Two thousand five hundred people who visited Shimane Institute of Health Science for their annual medical check-up from September 1998 to August 1999 were prospectively enrolled in the study. After routine medical examination, including an upper gastrointestinal study and an ultrasonographic examination, all subjects were asked standard questions to check for the presence of any symptoms that suggested dyspepsia. Helicobacter pylori infection was determined by using a serum IgG antibody concentration with an ELISA. RESULTS: Of the 2,500 persons investigated, 2,263 showed no abnormal finding in any medical examination. The presence or absence of symptoms and H. pylori infection was investigated in these 2,263 cases. Of these, 201 people (8.9%) experienced nausea, fullness and/or early satiety and were diagnosed as having dysmotility-like dyspepsia, while 118 people (5.2%) experienced pain localized to the epigastrium and were diagnosed as having ulcer-like dyspepsia. The frequency of these symptoms had a tendency to decline with age, although this was not statistically significant. In contrast, the rate of H. pylori infection increased with age. There was no significant relationship between H. pylori infection and any type of functional dyspepsia. CONCLUSIONS: Helicobacter pylori infection does not influence the prevalence of the dysmotility-like and ulcer-like dyspeptic symptoms.     

Correlation between body surface isopotential maps and left ventriculograms in patients with old inferoposterior myocardial infarction

In 24 patients with old inferoposterior myocardial infarction, body surface isopotential maps were compared with left ventriculographic findings. In 16 patients with asynergy restricted to the inferior and/or posterolateral segment, surface potential abnormalities due to infarction were observed during specific phases of QRS and in specific portions on the chest surface depending on the location and extent of ventricular severe asynergy (akinesis and dyskinesis). However, the remaining eight patients with coexisting severe asynergy in the anterior, apical, or septal segment showed surface potential maps quite different from those of the former patients. It is suggested that body surface isopotential maps are a useful clinical tool for detecting the location and extent of ventricular severe asynergy in patients with old inferoposterior myocardial infarction.     

Increased lysyl oxidase activity in culture medium of nonparenchymal cells from fibrotic livers

Lysyl oxidase, which plays an important role in collagen deposition in chronic liver diseases, was studied in nonparenchymal cell cultures from fibrotic human livers. Liver biopsy specimens were obtained from control patients without apparent hepatic disease, and from patients with chronic persistent hepatitis, chronic active hepatitis, or liver cirrhosis. Nonparenchymal cells from biopsy specimens were cultured. At the third passage of the culture, lysyl oxidase activity was measured in the culture medium and cell layer. Most of the activity in the culture medium of cirrhotic liver cells was significantly higher than that in the medium of liver cells from controls or from patients with chronic hepatitis, whereas no significant difference in activity was noted between chronic persistent hepatitis and chronic active hepatitis cells. In patients with chronic hepatitis, lysyl oxidase activity in the culture medium from liver cells of alcoholics was significantly higher than that in the medium from liver cells of nonalcoholics. Thus, increased lysyl oxidase activity was found in the medium of nonparenchymal cell cultures from patients with cirrhosis and from alcoholics with chronic hepatitis. This increased activity may be related to fibrotic processes in the liver.