A Case of a Pseudomalfunction of a DDD Pacemaker

DDD pacemaker pseudomalfunction occurred in a 65-year-old man. This was due to premature ventricular contraction (PVC) response option and cross-talk detection window, which are designed to protect against pacemaker related tachycardia or cross-talk. Pseudomalfunction disappeared by eliminating PVC response option.     

Quantitative immunohistochemical analysis of lymphocyte subsets in alcoholic liver disease

Abstract To investigate the role of lymphocytes frequently observed in the parenchyma of alcoholic liver disease (ALD), lymphocytes infiltrating into the liver were stained immunohistochemically with monoclonal antibodies (MoAb) and were quantitatively assessed by a morphometric analysis in 17 patients with ALD and, for comparison in five patients with chronic active hepatitis B (B-CAH). In patients with alcoholic hepatitis, the number of CD8⁺ lymphocytes in the hepatic lobule was similar to that in patients with B-CAH but was significantly greater than that in alcoholics with hepatic fibrosis (HF). The CD4/CD8 ratio in the hepatic lobule was low in both alcoholic hepatitis and B-CAH compared with that of alcoholic patients with HF. When Mallory bodies (MB) and lymphocytes were simultaneously stained with a specific antibody against MB and MoAb, respectively, only CD3⁺ and CD8⁺ lymphocytes were found to have a close contact with MB. These results suggest that in alcoholic hepatitis, hepatocyte necrosis may be partly mediated by immunological mechanisms involving cytotoxic T cells infiltrating into the hepatic lobule.     

Bilateral epididymal sarcoidosis presenting without radiographic evidence of intrathoracic lesion: Review of sarcoidosis involving the male reproductive tract

Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract. To date, only 59 cases of histologically proven sarcoidosis involving the male reproductive tract have been reported in the literature. We present here a case of bilateral epididymal sarcoidosis without radiographic evidence of intrathoracic lesion. A 46-year-old man presented with a one-week history of painless bilateral scrotal swellings. Physical examination detected multiple elastic firm nodules on both sides of the scrotum which showed no tenderness. The nodules seemed to involve the entire bilateral epididymides. Some irregularly shaped hypoechoic masses in the bilateral epididymides were identified on gray scale ultrasonography. On magnetic resonance images, the bilateral epididymides were seen to be enlarged, heterogeneous and nodular without any signs of testicular involvement. The lesion showed a slightly high signal intensity on the T2-weighted image. Pathological evaluation following bilateral epididymectomy found non-caseating epithelioid cell granulomas with giant cells in epididymal tissue, thus confirming a diagnosis of sarcoidosis. Gallium-67 scanning showed additional small hot spots in the anterior chest wall and extremities. Open biopsy of a superficial papular lesion in the dermis of the right upper arm was performed and pathological findings indicated sarcoid granulomas. This report also includes a review of the literature pertaining to sarcoidosis of the male reproductive tract.     

Recovery of health related quality of life after radical prostatectomy in Japanese men: A longitudinal study

BACKGROUND: We performed a longitudinal survey of health related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The present study started with self-reported HRQOL assessments provided by 72 patients who received only RP. The RAND 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index were administered before and 3, 6 and 12 months after RP. RESULTS: Patients who underwent RP showed problems in some domains of general HRQOL, but these problems diminished over time. Urinary function declined substantially at 3 months and continued to recover at 6 and 12 months, but scored lower than the baseline. Urinary bother at 3 months had a significant decrease, but at six months it turned out to be the same as the baseline. The data of sexual function and bother showed a substantially lower score after RP. The sexual bother score of the younger men was significantly worse than that of the older men. Those who underwent nerve sparing procedures experienced significantly better recovery of urinary and sexual functions than the non-nerve sparing group. CONCLUSION: Despite reports of problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Deterioration of the sexual domain was remarkable throughout the postoperative period. Therefore, careful attention should be given to preoperative counseling, especially for younger patients.     

Differential neuromuscular effects of vecuronium on the adductor and abductor laryngeal muscles and tibialis anterior muscle in dogs

We have studied in dogs the neuromuscular blocking effects ofvecuronium on the cricothyroid (CT) (a tensor muscle of thevocal folds) and posterior cricoarytenoid (PCA) (sole abductormuscle of the vocal folds) muscles of the larynx and the tibiaIis anterior (TA) muscle. The lungs of the animals were ventilatedmechanically with 0.2% halothane and oxygen. Electromyography(EMG) was performed on the CT, PCA and TA muscles by insertingfine wire electrodes. The evoked compound EMG responses of thethree muscles were measured simultaneously in an identical mannerby stimulating supramaximally the superior laryngeal, recurrentand sciatic nerves at 0.1 Hz and 0.2 ms. Vecuronium was infusedcontinuously at a rate of 0.01 mg kg^–1 min^–1 for8 min. Vecuronium produced more intense neuromuscular blockin the CT than in the PCA and TA muscles. The rate of recoverywas significantly slowly in the CT compared with the PCA andTA muscles. This study confirms the difference in sensitivitybetween laryngeal and peripheral muscles, demonstrating thatthe intrinsic laryngeal muscles do not all behave similarlyafter administration of vecuronium. (Br. J. Anaesth. 1994; 72:321–323)     

Potential benefits of combining cytosine deaminase/5-fluorocytosine gene therapy and irradiation for prostate cancer: Experimental study

BACKGROUND: The purpose of this study was to investigate the potential of combining cytosine deaminase/5-fluorocytosine (CD/5-FC) gene therapy and radiation therapy (either external beam radiation or radioimmunotherapy [RIT]), for the treatment of prostate cancer. METHODS: Tumor xenografts of CD-transduced LNCaP cells grown in the testes of severe combined immunodeficiency (SCID) mice were used to evaluate antitumor effect. The mice were injected intraperitoneally with 500 mg/kg of 5-FC, or with 5, 15 or 30 mg/kg of 5-fluorouracil (5-FU), for 9 days. The tumors were treated with fractionated radiation at a dose of 1 or 3 Gy/day for 3 days, or I-131 labelled anti-prostate specific antigen (anti-PSA) monoclonal antibody (mAb) administration at a subtherapeutic dose of 20 or 80 micro Ci. Intratumoral and serum concentrations of 5-FU were measured using high performance liquid chromatography. RESULTS: Mice treated with CD/5-FC gene therapy presented a significant tumor growth inhibition comparable to that obtained with 15 mg/kg, 5-FU systemic administration without marked weight loss. Treatment with CD/5-FC gene therapy resulted in higher tumor but lower serum concentrations of 5-FU than treatment with systemic 5-FU chemotherapy. An additive antitumor effect was obtained when CD/5-FC therapy was combined with 1 Gy irradiation, which by itself did not produce a significant antitumor effect. However, the efficacy of CD/5-FC therapy was not enhanced when combined with RIT, probably due to poor accumulation of the mAb as the tumor/blood ratio never exceeded 1. CONCLUSION: These findings indicate that CD/5-FC gene therapy for prostate cancer may function with enhanced antitumor effect when combined with external beam radiation. However, combining CD/5-FC gene therapy and RIT using an anti-PSA mAb may not be effective because of insufficient accumulation of the mAb at the target tumors.     

Effects of induced hypotension on arterial blood–gases under spontaneous breathing

The effects of deliberate hypotension on both Pao₂ and Paco₂ were investigated under isoflurane anaesthesia with spontaneous breathing from a laryngeal mask. Lumbar epidural block was introduced; anaesthesia was induced with thiamylal (4 mg kg^-1) and maintained with 0.5% isoflurane in nitrous oxide (4 1 min^-1) and oxygen (2 1 min^-1) under spontaneous breathing. After that nitroglycerin, trimetaphan or prostaglandin E₁ were used to induce a hypotension of 70% of control. All three drugs significantly decreased Pao₂, from 19.9 ± 3.3, 19.2 ±2.7, and 19.6 ± 3.1 kPa to 14.6 ± 1.9, 16.6 ± 2.2, and 16.2 ± 2.4kPa (mean ± s.d.), respectively; none of them increased Paco₂. In spite of the sparing of functional residual capacity under spontaneous breathing, the levels of reduction of Pao₂ were the same as levels reported in paralyzed and mechanically ventilated subjects. In conclusion, under deliberate hypotension Pao₂ decreases to a considerable degree, even under spontaneous breathing, presumably not because of alveolar hypoventilation, but because of the suppression of hypoxic pulmonary vasoconstriction by the drugs used in this study.     

Influence of Urethral Sphincter Incompetence on Bladder Shape and Function in Myelodysplastic Children

Objectives: This study was undertaken to investigate the influence of the urethral function on bladder shape and function in myelodysplastic children. Methods: Of 39 myelodysplastic children, 30 were treated with intermittent catheterization. The diagnosis of internal sphincter incompetence (SI) was based on cystographic findings (open bladder neck) and that of external SI on urodynamic findings (underactive external sphincter identified on electromyography and maximum urethral closure pressure of less than 50 cm H₂O). Follow up included evaluation of bladder deformity and compliance. Results: The mean observation period was 8.6 years. In the 11 patients with external SI, bladder deformity and compliance significantly improved as a result of intermittent catheterization. However, of 12 patients with overactive sphincter and/or closure pressure of 50 cm H₂O or more, eight showed deterioration or no improvement in bladder deformity, and three showed upper urinary tract deterioration. Conclusion: These results indicate that an increase in urethral resistance may lead to deterioration of bladder shape.     

Comparison of the effects of sevoflurane, isoflurane and halothane on indocyanine green clearance

We have examined the effects of inhalation anaesthetics on indocyaninegreen (ICG) clearance, as an index of hepatic function, in patientsundergoing elective surgery. Recently, a new method has beendeveloped to measure in real-time the disappearance rate ofICG from plasma. This method eliminates the multiple samplingand delay of the conventional ICG test. ICG clearance is displayedas two indices: K (ICG disappearance rate) and R₁₅ (ICG retentionrate 15 min after injection of ICG 0.5 mg kg^–1 This measurementwas performed in patients before and after 1 MAC of sevoflurane(n = 6), 2 MAC of sevoflurane (n = 6), 1 MAC of isoflurane (n= 6), 2 MAC of isoflurane (n = 6), 1 MAC of halothane (n = 6)or 2 MAC of halothane (n = 6) without surgical stress. Althoughmean arterial pressure decreased significantly at 1 and 2 MACof sevoflurane, 2 MAC of halothane, and 1 and 2 MAC of isoflurane,ICG clearance was maintained at awake levels, except at 2 MACof halothane (K mean - 33 (SEM 3)%, R = + 90 (3)% from awakevalues). We conclude that sevoflurane and isoflurane have amore favourable effect on liver circulation than halothane.