Alteration of bile acid metabolism in two-thirds hepatectomized rat

Bile acid metabolism after two-thirds partial hepatectomy (PH) in rat was studied. Bile acid kinetics (i.e. synthesis rate and pool size) were determined by wash out method combined with gas liquid chromatography, and serum bile acids by gas liquid chromatography-mass spectrometry. Serum bile acid concentration was highest on the third day after PH, as the liver regeneration progressed but it gradually decreased with increasing cholic acid (CA)/chenodeoxycholic acid (CDCA), reflecting impaired hepatic uptake of bile acids and/or cholestasis during the early post-hepatectomy period. Predominance of CA in bile acid synthesis, pool, and biliary secretion was also found. On the third day after PH, liver weight recovered to 66% of the control value, but enhancement of bile acid synthesis was not observed. Consequently, pool size remained at 50% of control. On the seventh day, synthesis of bile acid, especially of CA, was enhanced and pool size and liver weight returned to 68 and 72% of the respective control values. Bile acid synthesis was returned to the control value on the fourteenth day with concomitant restoration of liver weight and bile acid pool size. These changes in bile acid kinetics parallel the events during hepatic regeneration after PH.     

Acoustic Screening for Laryngeal Cancer

An acoustic screening method for indicating the possible presenceof laryngeal cancer was investigated. Three acoustic parameters,comprising perturbations in pitch-period and peak-amplitudesequences, and vocal noise, were measured from a sustained vowel,e, spoken by the subjects taking part in the investigation.Experiments to discriminate between normal and cancer groupswere performed with voice samples taken from 64 normal controlsubjects and 57 patients with laryngeal cancer. Experimentswere also carried out to test the perceptual significance ofthe three parameters. From the results, we have been able toconclude that their combined use will enable us to build anacoustic screening system for laryngeal cancer.     

Effects of vaso-active agents on hepatic function and blood gases in patients with cirrhosis: A study of vasopressin and nitroglycerin

The effects of vaso-active agents on hepatic function and splanchnic oxygenation were studied in 17 patients with cirrhosis and portal hypertension. Eight patients received vasopressin (0.3 iu/min) and nine patients received nitroglycerin (50 micrograms/min). Both drugs caused a significant reduction in the portal venous pressure gradient. Vasopressin infusion significantly decreased intrinsic clearance of indocyanine green (-23%, P less than 0.01). This may be due to a decreased hepatic perfusion (-28%, P less than 0.01) and portal venous oxygenation (-15% in portal venous oxygen tension, P less than 0.05). In contrast, no changes in hepatic perfusion and portal venous oxygenation were observed after nitroglycerin infusion. Nitroglycerin did not decrease intrinsic clearance of indocyanine green. These results suggest that vasodilators, rather than vasoconstrictors, might be welcome in the treatment of patients with cirrhosis and portal hypertension.     

The peritoneal equilibration test variables in pediatric CAPD patients

The peritoneal equilibration test (PET) is generally accepted as a valuable tool in individualizing continuous ambulatory peritoneal dialysis (CAPD) treatment schedules in adults. However, the classification of peritoneal permeability as described by Twardowski is not available for children due to differences in peritoneal transport abilities. In this paper, we report the results of the PET for 20 patients aged from 1.5 to 24 years (mean 10.3 years), who started CAPD therapy at age 0–15 years, using Twardowski's standardized technique. D/P creatinine (dialysate to plasma ratio of creatinine at 4 h), D/D₀ glucose (the ratio of dialysate glucose at 4 h dwell time to dialysate glucose at 0 dwell time), and the residual volume (RV) in the abdominal cavity were calculated. The mean and standard deviation values for D/P creatinine and D/D₀ glucose were of a higher permeability level than those reported in Twardowski's data. Furthermore, a significant correlation of creatinine and glucose with fluid drainage ability of the peritoneum were observed. A large amount of RV (425±125 mL/m²) was detected in the patients' peritoneal cavity and this had a significant correlation with dialysate leak occurrences. The authors suggest that the RV would be an indicator for leaks and especially latent leaks. The cause of a large RV is unknown, but there is a probability that drainage volume and transport rates of metabolites decrease because the concentration of the instilled dialysate is immediately diluted by a large RV within the peritoneum.     

Chronic urticaria associated with aseptic meningitis: An atypical urticarial vasculitis?

The patient was a 7-year-old girl with early onset urticarial cutaneous lesions and was later complicated with aseptic meningitis. Her skin lesions occurred in the infantile period and were diagnosed as urticaria, but did not disappear with antihistamines and were recurrent and persistent. In addition, she had experienced an episode of headache about once a month since 1991, when she was 4 years old, and was diagnosed as aseptic meningitis. All studies including skin biopsy for urticarial vasculitis (UV) and systemic lupus erythematosus (SLE) were negative except for the data from non-specific inflammations. A systemic corticosteroid therapy dramatically reduced her symptoms. An unusual clinical course for this patient is described. It might suggest that this case is a presentation of the disease entity of UV, chronic urticaria and possibly SLE. To our knowledge, a similar case has not been previously reported.     

Neurally mediated syncope complicated with paroxysmal atrial fibrillation

Recently, it has come to be accepted that the result of the tilt test is specific to neurally mediated syncope (vasovagal syncope). Only rarely is a case of paroxysmal atrial fibrillation without any organic diseases in childhood reported. A case reported here of a 14-year-old boy with neurally mediated syncope; which was complicated by paroxysmal atrial fibrillation, and which was diagnosed by performing the tilt test. Atrial fibrillation can be induced by the extraordinary stimulation of the vagal nerve during syncope. In a child, neurally mediated syncope complicated with paroxysmal atrial fibrillation has not been previously reported.     

Wolf运动功能量表的因子分析及信度和效度研究

目的探讨Wolf运动功能量表（WMFT）评定脑卒中患者上肢运动功能的信度、效度及内郎一致性，同时进行因子分析。方法采用WMFT对22例脑卒中患者进行评定，同时测定作业时间。12例患者瘫痪侧上肢进行WMFT作业活动时，由检查者对其摄像，用于信度检验。进行WMFT评定的同一周内用简易上肢功能评定量表（STEF）再次评估患者上肢功能。结果检查者内及检查者间的功能评分平均值信度分别为0．96和0．93，作业时间中位数的信度均为0．99。WMFT功能评分的内部一致性很高，Cronbach’s α值为0．96。根据原始因子的特征值，提取2个特征值大于1的因子，第1个主因子与上肢近端功能有关，第2个主因子与手指功能有关。WMFT功能评分平均值及作业时间中位数均与STEF明显相关（分别为r=0．75，P〈0．001；r=0．73，P〈0．01）。结论WMFT具有较高的信度、效度及内部一致性，通过因子分析可将其作业活动分为3组。WMFT项目可能过多，删除部分项目能否仍保持WMFT较高的效度和信度有待进一步研究。     

Nicorandil, a Potassium Channel Opener, Abolished Torsades de Pointes in a Patient with Complete Atrioventricular Block

TdP is a serious complication of AV block. We report a case of complete AV block with QT prolongation who had bouts of TdP resistant to lidocaine and isoproterenol. Temporary pacing could not be performed, because insertion of a pacing lead triggered TdP that deteriorated into ventricular fibrillation. Nicorandil, a potassium channel opener, shortened the QT interval and abolished TdP. This may suggest that potassium channel opening drugs are clinically effective against TdP associated with bradycardia-dependent QT prolongation.     

CASE REPORT: A patient who developed an amoebic liver abscess during treatment with interferon

A 65-year-old female received recombinant interferon (IFN) α-2b daily for the treatment of chronic hepatitis C. Fever (39°C or higher) developed 14 days after the start of administration. Abdominal computed tomography suggested multiple liver abscesses, which had not been detected before IFN administration. An autopsy revealed an amoebic liver abscess. A subclinical infection of Entamoeba histolytica in this case developed into amoebic liver abscess during IFN administration.