The Internal Thoracic Artery and Its Branches After Coronary Artery Anastomoses in Pediatric Patients

The internal thoracic artery has been favored because of its superior early and late patency for coronary artery bypass grafting (CABG) in pediatric patients. We have studied the angiographic changes of the internal thoracic artery and its side branches before and after CABG with internal thoracic artery to the left anterior descending artery. The internal thoracic artery with remaining thymic or pericardial branches was patent but showed enlargement of the branches in the early period after the operation, and a postoperative exercise test suggested a remaining ischemic lesion in the bypass. Angiogram taken 1 year after CABG demonstrated the grown internal thoracic artery with disappearance of most of the side branches, which had been enlarged 1 month after the operation. Our findings suggest the importance of ligation of the whole proximal internal thoracic artery branches to maintain good early and late patency.     

Nipradilol, a new β-blocker with vasodilatory properties, in experimental portal hypertension: A comparative haemodynamic study with propranolol

The haemodynamic effects of nipradilol, a new non-selective β-adrenoreceptor blocker with vasodilating actions like nitroglycerin, were examined in rats with portal hypertension due to portal vein stenosis. Portal hypertensive rats were divided into five groups receiving infusion of placebo, 3 mg of propranolol, 300, 600 and 1200 μg of nipradilol. At its highest dose, nipradilol achieved a reduction of 34.4 ± 4.4% in heart rate which was similar to that in the propranolol group (36.5 ± 2.4%). Also for other systemic haemodynamic parameters, the nipradilol 1200 μg group exhibited changes not significantly different from those in the propranolol group; mean arterial pressure (- 13 vs - 14%), cardiac index (- 37 vs - 31%) and systemic vascular resistance (+ 29 vs+ 32%). In contrast to the similar changes in the systemic circulation, a 1200 μg dose of nipradilol lowered portal pressure significantly more than propranolol (- 4.3 ± 0.6 vs - 2.9 ± 0.2 mmHg, P≤ 0.05). Nipradilol then reduced portal blood flow by 22% (P≤ 0.05) without a significant change in portocollateral resistance. On the other hand, propranolol not only caused a reduction in portal blood flow of 30% (P≤ 0.01), but also an increase in portocollateral resistance of 21% (P≤ 0.05). The results suggest that nipradilol may ensure a more effective control of portal hypertension than propranolol, presumably via its venodilatory action on portocollateral vessels.     

Adult Wilms'' tumor mimicking hemorrhagic renal cyst

A 36-year-old man presented with macroscopic hematuria associated with right flank pain. Examination of the patient revealed a cystic mass in the right kidney. Because the mass had increased in size, enucleation of the mass was performed. Histopathological findings revealed nephroblastoma, therefore, radical nephrectomy was performed. We believe the pathogenesis of the cystic formation to be a process in which a tumor that had developed in the pericalyceal region spontaneously ruptured, exuding urine into the perinephric space, forming a cystic mass. The patient is alive with no evidence of disease 24 months after the operation.     

Experience with flexible video cystoscope equipped with built-in high-frequency cauterizing element for transurethral resection of the bladder

We successfully treated three patients using the flexible video cystoscope (CYF-240A, Olympus, Japan) for superficial bladder cancer under local anesthesia and/or spinal anesthesia. The major advantage of this new technique is that surgeons can use digital pictures and high frequency cauterization. This new system provides good quality of life for bladder cancer patients experiencing frequent recurrences.     

Anatomical and histological studies of so-called Müllerian duct cyst

BACKGROUND: We examined so-called Müllerian duct cysts both histologically and immunohistochemically with anatomical observation to investigate the etiology of the 'Müllerian duct cyst'. METHODS: Five cystic lesions located in the prostatic midline were obtained from surgical specimens. A communication between the cystic lesion and the urethra via the utricular orifice was looked for and the specimens were subjected to histological and immunohistochemical testing. RESULTS: A communication between the cyst and the urethra was confirmed in four cases, but not in one case. Histological and immunohistochemical examinations of the epithelium lining indicated that its characteristics were identical to those of the prostatic utricle in all cases. CONCLUSIONS: The so-called Müllerian duct cyst exhibits features comparable to those previously described in the prostatic utricle. There is no evidence that these cystic lesions originate from the Müllerian duct remnant, at least in the epithelial lining. We suggest that they should be termed a prostatic utricular cyst or cystic dilation of the prostatic utricle, depending on whether an outlet to the urethra is absent or present, respectively.     

Diagnostic Value of 201Tl-chloride Scintigraphy for Thyroid Tumors

Among 114 patients with thyroid disease examined by ²⁰¹Tl-chloridescintigraphy, 101 were given a histological diagnosis. Of 28cases of thyroid carcinoma, 22 (78.6%) were positive. In threeof the 22, an obvious accumulation of ²⁰¹Tl-chloride was revealedin the metastatic lymph nodes of the neck and mediastinum. Only 12 of 50 (24%) cases of thyroid adenoma were positive.In comparison, all cases of hyperthyroidism and chronic thyroiditiswere positive and all cases of subacute thyroiditis were negative.The histological types of thyroid tumor were examined. Of 22cases of papillary carcinoma, 18 (81.8%) were positive. In fourcases which revealed negative figures, the tumor was almostcompletely encysted in three and the tumor was small in theother. Of the adenomas, eight cases of tubular adenoma and threeof trabecular adenoma were all positive, but colloid adenomaand thyroid cyst cases were all negative. It was concluded that ²⁰¹Tl-chloride has no specific affinityfor malignant tumors and cannot be used to discriminate betweencarcinoma and adenoma, but surgery should be indicated for noduleswhich are positive scanning by ²⁰¹Tl-chloride.     

Effects of transforming growth factors on the wound repair of cultured rabbit gastric mucosal cells

We have evaluated the role of two different transforming growth factors in the restoration of rabbit primary cultured gastric mucosal cells using a new wound repair model. After forming confluent monolayer cell sheets, a wound with a constant size (2 mm²) was made using a rotating silicon tip. Either TGFα (0.1–100 ng/mL) or TGFβ₁ (0.1–10 ng/mL) was added to the medium and the process of wound repair was monitored and analysed quantitatively by an image analyser. Cell proliferation was examined by BrdU staining. After wounding, the cells fronting the wound formed lamellipodia and migrated towards the centre of the wound. In the control group, the wound healed completely 48 h after wounding. TGFα promoted wound healing and the wound healed within 36 h in the presence of TGFα. TGFα increased the number of proliferative cells and they appeared in an earlier phase of healing than in controls. TGFβ did not have any effect on the wound repair process. In conclusion, TGFα promotes mucosal cell repair processes in the rabbit primary cultured gastric mucosal wound repair model in a dose-dependent manner by accelerating migration and proliferation. TGFα may modulate the healing process of a gastric ulcer or erosion in vivo.     

Anaesthetic considerations in a child with adrenoleukodystrophy

A child with asymptomatic adrenoleukodystrophy (ALD) who uneventfully underwent an operation for undescended testis under halothane-nitrous oxide anaesthesia is presented. The normal hormonal responses to surgical stress were observed. The potential problems of disorders of the adrenal cortex, the central nervous system, and skeletal muscle associated with the condition are discussed. Rapid-ACTH test may be a useful method for the evaluation of the adrenocortical function in this disease. It is proposed that a patient with ALD should receive a single dose of steroid regardless of the result of the rapid ACTH test.