Echographia as a symptom of interictal state in an epileptic patient: A case report

Abstract Echographia is a phenomenon in which a patient continuously translates verbal stimuli into writing. We encountered a patient with epilepsy who developed visual echographia during interictal periods. In this case, echographia was observed during two different periods, namely the period of disturbed consciousness after the epileptic seizure and the period of clear consciousness after suppression of the seizures. Disinhibition due to disturbance of the consciousness is considered to have been the cause of echographia in the former period. In the latter period, it is considered that echographia was caused by the release of lower function from suppression of upper function by brain dysfunction, as the after effect of status epilepticus. As echographia can be observed in epileptic patients, attention and careful observation by epileptologists is needed.     

Photodynamic Therapy Using a New Photosensitizer Gallium Porphyrin Complex in the Treatment of Experimental Pancreatic Cancer

Abstract: To determine the therapeutic effect of photodynamic therapy (PDT) using a new photosensitizer 2.4-bis (1-decyloxyethyl)-Ca-deuteroporphyI diaspartic acid (Ga -DP), 20 female Syrian golden hamsters with experimentally induced pancreatic cancer were irradiated with a pulsed Nd : YAG laser with a Q switch after administration of Ga -DP. To induce pancreatic cancer, N-nitroso-bis-(2-oxypropyI) amine (BOP) at 10 mg/kg body weight was injected subcutaneously once a week for eight weeks. Ten of the twenty animals served as a control group. The other ten received laser treatment beginning 20 weeks after BOP administration. Twenty-four hours after intravenous injection of 3 mg/kg Ga-DP, pulsed Nd : YAG laser irradiation was performed using a Q switch with 1 W of power output for 3–5 minutes at a frequency of 300 Hz. Elimination or necrosis of the entire tumor resulted with tumors 6–10 mm in diameter in 6 animals. In 3 animals which had tumors more than 12 mm in diameter, cancer cells remained at the margins of the treated area. These results were felt to not only reflect the thermal effect of laser therapy, but also the effect of PDT combined with Ga-DP. They suggest that Ga-DP could become a clinically valuable photosensitizer in combination with PDT. (Dig Endosc 1994; 6 : 28–33)     

Morphological and Functional Evaluation of Gastric Ulcer Healing and Recurrence by Endoscopic Ultrasonography

Abstract: The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI-IV ulcers was significantly higher than those in UI-II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurrence.     

A Case of Dislodged Atrial Screw-In Lead with Migration to the Ventricle 1 Year Postoperatively

We report a rare case of a 53-year-old woman with a dislodged atrial screw-in lead that migrated to the ventricle 1 year after pacemaker implantation. While such an event is quite unusual, we should be aware of its possibility.     

Short report: effect of sucralfate on angiogenesis in granulation tissue of acetic acid-induced gastric ulcers in rats

We investigated the effect of sucralfate on angiogenesis in granulation tissue of gastric ulcers induced by acetic acid in rats using the carmine dye method. Intragastric administration of sucralfate at a dose of 500 mg/kg twice daily for 9 days significantly accelerated ulcer healing and significantly increased the extent of angiogenesis in the ulcer base on the tenth day after ulcer induction. As we reported previously, intragastric administration of cimetidine at a dose of 100 mg/kg once daily for 9 days decreased the extent of angiogenesis on the tenth day. However, combination treatment using sucralfate and cimetidine accelerated ulcer healing significantly, without altering the extent of angiogenesis. It is concluded, therefore, that the treatment with sucralfate may be effective in peptic ulcer disease from the standpoint of angiogenesis in the ulcer base.     

Leukocyte Drumsticks in Chronic Granulocytic Leukemia and Related Disorders

1. The drumstick and other nuclear appendages of the nuclei of polymorphonuclear neutrophils from patients with chronic granulocytic leukemia(CGL), leukemoid reactions and inflammatory leukocytoses were studied.

2. The drumstick counts of the leukocytes of patients with CGL wereabnormally low. In contrast, the counts in the leukocytes from patients withthe other disorders were not reduced. The low counts increased rapidly inresponse to treatment and were maintained at normal levels during remission.

3. The normalization of drumstick counts in CGL paralleled the leukocytealkaline phosphatase and catalase concentrations.

4. The number of sessile nodules and small clubs in each of the disordersstudied was moderately reduced. Following treatment, the counts returnedto normal. This suggests a relationship between the development of theseappendages and hyperproliferation of neutrophils.

Submitted on July 10, 1961 Accepted on August 1, 1961     

Alkaline Phosphatase Isoenzymes in Carcinoma Tissue of Gastro-intestinal Tract

The enzymological and immunological properties of alkaline phosphatase (ALP) isoenzymes in carcinoma tissues of the gastro-intestinal tract were compared with those of purified human intestinal, placental and hepatic ALP's to investigate the gene expression of gastro-intestinal cancer cells. The results were as follows: ALP obtained from carcinoma tissues of 77 patients was separated into 6 bands (ALPa, ALPb, ALPc, ALPd, ALPe and ALPf) by polyacrylamide-gel disc electrophoresis. It was concluded that ALPa was similar in its enzymological and immunological properties to hepatic-type ALP, ALPb was similar to placental-type ALP (Regan ALP or Nagao ALP), ALPc to intestinal-type ALP (metaplasia ALP), ALPd to hepatoma-type ALP (Warnock's variant ALP), ALPe to intestinal-type ALP except for electrophoretic mobility, and ALPf was similar to hepatic-type ALP except for neuraminidase sensitivity. ALPb appeared in 16 out of 55 cases (29%) of gastric carcinoma, and 2 out of 21 cases (10%) of colonic carcinoma. ALPd appeared in 4 out of 55 cases (7%). ALPe appeared in 2 out of 55 cases (4%) of gastric, and 3 out o 21 cases (14%) of colonic carcinoma. ALPf appeared in 1 out of 55 cases (2%) of gastric, and 1 out of 21 cases (5%) of colonic carcinoma. These ALP isoenzymes (ALPb, ALPd, ALPe and ALPf) probably originate from the cancer cells themselves and may represent an abnormal gene expression of cancer cells in the process of onco-developmental differentiation.     

Clinical Significance of QRS Duration During Ventricular Pacing

To clarify the clinical significance of an abnormally prolonged paced QRS duration, we studied 114 patients who had undergone pacing for atrioventricular block (AVB). Patients were divided into two groups: group I consisted of 29 patients with at least one paced QRS duration greater than or equal to 180 msec during the follow-up period; group II consisted of 85 patients with paced QRS durations less than 180 msec. The clinical background, QRS complexes before pacing, and the echocardiographic findings were assessed. Males (P less than 0.05), those with H-V block (P less than 0.05) and a wider QRS complex of conducted and escape beats (both P less than 0.01) were dominant in group I. The incidence of underlying heart disease was greater in group I than in group II (83% vs 32%, P less than 0.01). Reduced left ventricular ejection fraction (LVEF) and increased left ventricular end-diastolic dimension (LVDd) were more prominent in group I than in group II (LVEF 0.49 +/- 0.17 vs 0.68 +/- 0.10, P less than 0.01, LVDd 57.1 +/- 7.9 mm vs 48.5 +/- 5.6 mm, P less than 0.01). The paced QRS duration correlated with LVEF (r = -0.61) and LVDd (r = 0.81). A paced QRS duration greater than or equal to 180 msec was sensitive and specific for a LVEF less than 0.5 (83.3% and 85.2%) and LVDd greater than or equal to 60 mm (100% and 81.4%). We conclude that patients with a prolonged paced QRS duration have more serious heart disease, and the paced QRS duration can be a useful indicator of impaired LV function.     

Inhibitory effect of local anaesthetics on reactive oxygen species production by human neutrophils

Background: Reactive oxygen species (ROS) generated from neutrophils accumulated in various major organs are thought to play a pivotal role in the pathogenesis of host auto-injury. Lidocaine has been shown to reduce the injury. We investigated the effect of local anaesthetics (lidocaine, mepivacaine and bupivacaine) on ROS production by neutrophils using an in vitro system.
Methods: We measured the production of superoxide (ferric-ytochrome c method), hydrogen peroxide (H₂O₂: scopoletin fluorescence technique), and hydroxyl radical (OH.: ethylene gas method) by neutrophils isolated from human adult volunteers in the absence and presence of lidocaine (2–200 μg/mL), mepivacaine (3–300 μg/mL), and bupivacaine (3–300 μg/mL). We also measured the ROS generation in a cell-free (xanthinexanthine oxidase) system.
Results: Lidocaine and mepivacaine at higher levels significantly decreased the production of ROS by neutrophils. However, these local anaesthetics at clinically relevant blood concentrations had no effect on the levels of ROS. Furthermore, lidocaine and mepivacaine failed to reduce ROS generated by the cell-free system. Bupivacaine did not decrease ROS generation by either generating system.
Conclusion: In conclusion, in the present in vitro system, only concentrations of lidocaine and mepivacaine 100-fold higher than clinically feasible ones reduced ROS production by human neutrophils. However, the local anaesthetics at clinically relevant blood concentrations had no suppressive effect. Further studies using in vivo systems are required to elucidate the inhibitory effects of local anaesthetics on ROS generation in clinical settings.