Successful Endoscopic Treatment of Diffuse Antral Vascular Ectasia and Early Gastric Carcinoma in an Aged Patient

Diffuse antral vascular ectasia and a lla type early gastric cancer were detected in an 83-year-old male patient through an endoscopy during treatment for iron deficiency anemia. Monopolar electrocoagulation was effective for eradication of red spots which represented ectatic vessels. Five sessions of the therapy resulted in the ablation of almost all of the vascular lesions, negative fecal occult blood tests and improvement of his anemia. The lla lesion was endoscopically resected from the posterior wall of the upper body. Histologic examination demonstrated well differentiated adenocarcinoma confined to the mucosal layer. Both the vascular ectasia and carcinoma did not show any sign of recurrence after a year and a half.     

EARLY STAGE OF DEVELOPMENT OF TRANSPLACENTALLY INDUCED GLIOMA WITH ETHYLNITROSOUREA IN RATS

Proliferative activity of possible preneoplastic cells (subependymal cells and glioblasts), early neoplastic cells and glioma cells induced by transplacental ethylnitrosourea (ENU) treatment in the rat was analysed by historadioautography and electron microscopy. Labeling index of ²H–thymidine in subependymal cells was the highest in the cerebrum of postnatal age, but no difference was observed between the normal and ENU treated groups. Thus, preneoplastic cells could not be distinguished from normal cells by morphology and proliferative activity. Focus of early neoplastic proliferation was composed of rather heterogenous and less differentiated cells, such as oligodendroblast–, glioblast– and subependymal cell–like cells, and preferentially located around the periventricular areas. Labeling index of early neoplastic proliferation was very low although the value gradually increased with age. Proliferative activity of glioma cells was higher than that of the early neoplastic cells and lower than subependymal cells, and further differed according to the degree of differentiation and morphological type. Finally, it is suggested that glioma might develop mainly through the differentiation from the focus of early neoplastic proliferation. ACTA PATHOL. JPN. 33: 237–247, 1983.     

Intussusception in children of school age

BACKGROUND: There are only a few reports discussing the characteristics of intussusception developing in school-age children. The characteristics of these cases are discussed, with reference to previous literature. METHODS: The present study included eight cases of intussusception in school-age children among 143 intussusception patients treated on an inpatient basis at Nihon University Itabashi Hospital, during the 11 year period from 1993 to 2003. The remaining 135 patients were assigned to the infant group as controls. The clinical characteristics of intussusception in school-age children were compared with those of the condition developing in infants. RESULTS: The eight children of school age with intussusception ranged in age from 8 to 15 years (mean, 11.6 years), and consisted of five boys and three girls. The major symptom was abdominal pain, occurring in 100% (8/8). Bloody stools and vomiting were reported in two patients each (25%) from this group. The triad of abdominal pain, bloody stools and vomiting was recognized in only one child (12.5%) of this group. Two children (25.0%) had a palpable abdominal mass, and one child (12.5%) complained of diarrhea. None of the school-age children with intussusception had any antecedent infection; five, two and one patients had the ileo-colic type, ileo-ileo-colic type and ileo-ileal type of intussusception, respectively. Four underwent enema reduction and four underwent surgical reduction. One of the eight children (12.5%) had underlying organic abnormality; in the remaining children the condition was labeled idiopathic. One child developed recurrences. CONCLUSIONS: In school-age children intussusception is generally believed to be commonly secondary to underlying organic abnormality, but in the present study only one of eight school-age children had underlying organic abnormality; in the remaining children, the condition was labeled idiopathic. The major symptom in school-age intussusception was abdominal pain. Therefore this may need to be differentiated from appendicitis in children of school age. It is considered that abdominal ultrasonography (USG) is a simple and useful method for making the diagnosis of intussusception, and that diagnostic USG should be conducted in all school-age children presenting with acute abdominal pain.     

Goals and potential career advancement of licensed practical nurses in Japan

Aim To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). Background In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Method Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova ) and discriminative analysis were used. Results We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Conclusion Our results indicate that the ‘image of RNs’, and ‘role‐acceptance factors’ have an effect on career advancement intentions of LPNs. Implications for nursing management Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.     

A Case of Sacral Parasite

Abstract A case of sacral parasite is presented. A parasitic body with an incomplete lower limb was attached to the sacrococcygeal region of a female newborn at birth. The twins were easily separated by operation two days after birth. The parasite contained well developed small and/or large intestines, a multilocular cyst and a unilocular cyst. Histologically, the wall of the multilocular cyst consisted of tissues of three germ layers, such as central and peripheral nervous tissues, mature and immature intestine, pancreatic tissue, bronchial cysts, connective tissue, etc. The thick wall of the unilocular cyst consisted of central nervous tissue and connective tissue. The degree of differentiation of these tissues varied considerably. The parasite revealed no organ communication with the autosite. Since the operation, her growth and development have been favorable and no other abnormalities have been found.     

Effects of different bed sheets on bed climate and thermal response

Aim: The aim of this study was to investigate how bed climate changes when disposable waterproof sheets are used in addition to usual ones. Methods: Thirty healthy female students (20.1 ± 1.1 years) consented to participate in the study, and were divided into three groups (cotton sheet only, additional disposable rayon sheet, additional polyester sheet). The skin temperatures of the subjects, bed climates (bed temperatures and relative humidity) and subjective sensations were measured for 45 min. Results: Both skin and bed climate temperatures showed significant increases as time passed (P < 0.05). The humidity on disposable waterproof sheets was the highest among the three groups (P < 0.05). All subjects gradually began to feel warmer and wetter. Conclusion: These results suggest nurses should consider not only cost and convenience when they use waterproof sheets, but also bed climate. This will also help to prevent pressure ulcers.     

Early Gastric Lymphoma Coexisting with Reactive Lymphoreticular Hyperplasia (RLH) -A Case Report-

A 34-year-old female visited our hospital because of epigastralgia. We performed an upper gastrointestinal x-ray examination, and both conventional endoscopy and dye-spraying endoscopy (indigo-carmine contrast method). We diagnosed early gastric lymphoma which simulated Borrmann 3 type gastric cancer with IIb type early gastric cancer on the middle body and reactive lymphoreticular hyperplasia (RLH) of cobble stone-like granular pattern by endoscopic appearance on the lower body. Although dye-spraying endoscopy showed the details of the mucosa, it was very difficult to diagnose the lesions correctly by gross appearance alone. Because gastric lymphoma arises from the mucosal or submucosal layer and spreads in the mucosa diffusely, ultrasonic visualization by echo-endoscopy might be useful in the diagnostic procedure. We report a case of early gastric lymphoma coexisting with RLH; both lesions showed uncommon endoscopic features.     

Dispersion of Filtered P Wave Duration by P Wave Signal-Averaged ECG Mapping System:

INTRODUCTION: Although it is desirable to know drug efficacy before initiating antiarrhythmic therapy, there have been no methods for this evaluation. P wave signal-averaged ECG (P-SAECG) is useful to detect subtle changes in disturbance of atrial conduction. The purpose of this present study was to test whether P-SAECG mapping system would give any information on the efficacy of disopyramide on the prevention of paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: P-SAECG was performed before disopyramide treatment, at 3 hours after a single dose of oral disopyramide (200 mg), and after 4 weeks of disopyramide treatment (300 mg/day). After measuring the filtered P wave duration by the vector magnitude and mapping methods, we calculated filtered P wave duration dispersion, difference between the maximal and minimal filtered P wave duration within 16 chest leads at these three time points. Filtered P wave duration and filtered P wave duration dispersion before treatment were longer in 32 patients with symptomatic PAF than in 31 healthy volunteers. Disopyramide was effective for suppression of PAF in 17 patients and ineffective in 15 patients after 4 weeks of treatment. Filtered P wave duration was similarly prolonged at 3 hours in the two groups, whereas filtered P wave duration dispersion at 3 hours after the disopyramide administration behaved differently; it decreased in all of the effective group and increased in all of the ineffective group. The effective patients were prospectively followed with the same treatment for 6 months. In 16 (94%) of these 17 effective patients, no PAF was documented and they remained to be asymptomatic. CONCLUSIONS: Thus, measuring filtered P wave duration dispersion with the P-SAECG mapping method after a single administration may predict the long-term efficacy of disopyramide in patients with PAF.     

Preparations,solution conformations and molecular structures of N,N′-ethylene-bridged dipeptides and their derivatives

The solution conformations of novel dipeptides, methyl (2S, 3′S)-3-methyl-2-(2′-oxo-3′-isopropyl-1′-piperazinyl)-butanoate (EVV-OCH₃), methyl (2S, 3′S)-3-phenyl-2-(2′-oxo-3′-benzyl-1′-piperazinyl) propionate (EFF-OCH₃), and their derivatives (Boc-Gly-EW-OH, Boc-Gly-EVV-Gly-OH, and Boc-Gly-EFF-OH), were studied by ‘H NMR measurements and molecular mechanics calculations (1). The molecular structures of Boc-Gly-EVV-OH, Boc-Gly-EFF-OH, and the hydrochloride of EVV-OCH₃ were determined by X-ray analyses. The conformations of the piperazinone rings and the side chains of these oligopeptides were clarified.