Disseminated intravascular coagulation in a patient with progressive systemic sclerosis associated with necrotizing angiitis and generalized lymphadenopathy.

A 47-year-old woman with progressive systemic sclerosis developed disseminated intravascular coagulation in the course of her terminal illness. She also had complicating necrotizing angiitis and generalized lymphadenopathy. The likely relationship between disseminated intravascular coagulation and vasculitis is discussed.     

Streptozotocin effective for treating multiple-hormone-producing malignant islet cell tumor

A woman with a multiple-hormone-producing pancreatic islet cell tumor with hepatic metastases and with recurrent hypoglycemic attacks, was treated with steptozotocin. After this treatment, the elevated serum levels of insulin, C-peptide, glucagon and serotonin fell markedly and the low level of fasting blood glucose returned to normal. In accordance with these hormonal changes, scintiscan and CT scan revealed marked regression of the metastatic tumors in the liver. She is alive at this writing, five years after the streptozotocin treatment. Streptozotocin should thus be considered for treatment of malignant islet cell carcinoma with liver metastases and which is not amenable to surgery. Presented at the 6th World Congress of the Collegium Internationale Chirurgiae Digestivae, Lisbon, Portugal, September 19, 1980     

Hepatocyte proliferation in rats after ventromedial hypothalamic lesions: Immunoreactivity patterns of proliferating cell nuclear antigen (PCNA)

Ventromedial hypothalamic (VMH) lesions result in increased DNA content in the rat liver. However, little information is available concerning the proliferative activity and lobular distribution of different cell populations in VMH-lesioned rat liver. The aim of the present study was to quantitatiely assess these parameters in VMH-lesioned rat liver by measuring proliferating cell nuclear antigen (PCNA) reactivity. We investigated to determine whether this mitotic response involves acinar zones 1, 2, or 3. Changes in immunohistochemical labeling indices in rat liver were measured with an antibody against PCNA until 7 days after VMH lesioning. The effects of hepatic vagotomy on proliferation were also examined. Proliferation of hepatocytes in acinar zones 1–3 began to increase on day 1, and reached a maximum at 3 days. The area of most intense proliferation progressively shifted from acinar zone 1 to zone 3 in several days. The proliferation was completely inhibited by hepatic vagotomy, indicating that VMH lesions induce cell proliferation in rat liver via hepatic vagus nerve activity. This study implicates the information available on neural factors which initiate hepatocyte proliferation. (Received Sept. 4, 1997; accepted Dec. 19, 1997)     

A case of spontaneous superficial temporal artery aneurysm

A rare case of a 14-year-old boy with a spontaneous (true) aneurysm of the superficial temporal artery is presented. The mass in the right parietal region was pulsatile and gradually enlarged in size for the last several months without any notable history of head trauma. The mass was successfully removed by surgery and has proved histopathologically to be a true aneurysm. While almost all cases of the superficial temporal artery aneurysm reported are traumatic ones, the true aneurysm of this artery which is verified by angiography is extremely rare. The pathology, etiology and treatment of this true aneurysm of the superficial temporal artery were discussed.     

Central giant cell granuloma of the temporal bone.

We present two cases of central giant cell granuloma in the temporal bone. CT showed an enhancing tumor causing a smoothly margined temporal squamosa and floor of the middle fossa. External carotid angiograms showed tumor stain mainly supplied by the temporal branches of the internal maxillary artery. In one case, MR images showed a hypointense mass on both T1- and T2-weighted images that was thought to reflect the pathologic character of this lesion.     

Balloon electric shock ablation. Effects on ventricular structure, function, and electrophysiology

We have recently developed a transatrial balloon approach for intraoperative endocardial mapping of ventricular tachycardia, which can be performed in the intact ventricle. In selected patients, we have eliminated the arrhythmia by passing a series of electric currents through specific beads on the balloon array. The goal of this new technique, balloon electric shock ablation, is to create a homogenous scar in the subendocardial target area identified by mapping. Experimental data exist on the effects of catheter delivery of electric discharges to the myocardium, but no data are available on the effects of balloon electric shock ablation. We have performed balloon electric shock ablation in animals (nine cathodal shocks of 100 J given through a 4 cm2 electrode grid). Ventricular function was assessed at 6 weeks and compared with function after a simple ventriculotomy and with function in control animals having no operation. Gated nuclear ventriculograms were obtained during volume loading. Myocardial performance and diastolic pressure volume relationships were determined for the three groups. After balloon electric shock ablation or ventriculotomy, left atrial pressures were increased at similar end-diastolic volumes, which indicated decreased ventricular compliance. The trend reached statistical significance (compared with data from control animals) only in the group undergoing balloon electric shock ablation. Myocardial performance (stroke work index/end-diastolic volume relationship) was unchanged in the three groups. In the long-term balloon electric shock ablation preparation, an electrophysiologic study (including burst pacing) failed to induce ventricular arrhythmias. At 6 weeks, the lesion created by balloon electric shock ablation was a layer of homogenous mature scar with sharply defined borders. There was no evidence of additional injury to the surrounding myocardium or to the mitral valve apparatus. These studies show that delivery of a series of electric shocks through a 1 cm balloon grid of electrodes can create an area of homogeneous, electrically inert scar and that this procedure when performed in healthy dog hearts has no significant effect on the structure and function of the rest of the left ventricle.