Healing of Ulcers in Early Gastric Cancers: Supplementary Report

It has already been confirmed by several investigators thatulcers in early gastric cancers show significant healing withantacids and anticholinergics. This paper presents 10 casesin which ulcers in malignant lesions healed to form scars, demonstratinggastroscopic and histological findings. The purpose of the presentpaper is to emphasize that a trial medical therapy for gastriculcers is not always reliable for differentiation of the benignfrom the malignant lesions.     

Effects of Granulocyte Transfusion and Combination Antibiotic Therapy on Documented Septicemia in Patients with Acute Leukemia

A total of 30 episodes of documented septicemia in 25 patientswith acute leukemia have been analysed to evaluate the efficacyof granulocyte transfusion therapy. Almost 90% of the septicemiawas caused by gram-negative bacteria such as Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae. The results showedthat in six out of 23 episodes (26.0%) patients treated withcombination antibiotic therapy alone responded, whereas in sixout of seven episodes (85.7%) patients given granulocyte transfusionplus combination antibiotic therapy responded. The differencewas statistically significant (p < 0.05). Granulocyte transfusionwas most effective in patients with aplastic or hypoplasticmarrows who failed to recover. The infecting organisms thatdemonstrated in vitro sensitivity to none or only one of theoriginal antibiotics were not eliminated by the antibiotic therapy,while 50% of the patients who were treated with more than twoantibiotics to which the infecting organisms were sensitivewere cured. More responses were observed in the transfusiongroup. Bone marrow status, appropriate antimicrobial agents,and early initiation of transfusion appear to be very importantin producing a beneficial clinical response.     

Double Atrial Responses to a Single Ventricular Impulse in Long RP' Tachycardia

Double atrial responses (DARs) to a single ventricular impulse have been described in patients with long RP' tachycardia. To define the determinants for the occurrence of DARs. 8 cases with long RP' tachycardia were examined. The mechanism of long RP' tachycardia was the orthodromic atrioventricular reciprocating tachycardia (AVRT) involving a slow conducting concealed accessory pathway in 4 cases and uncommon (fast-slow) type of atrioventricular nodal reentrant tachycardia (AVNRT) in the other 4 cases. Programmed and rapid ventricular pacing was performed during sinus rhythm and also rapid ventricular pacing during tachycardia (i.e., entrainment). The retrograde effective refractory period (ERP) and the retrograde maximal 1:1 conduction rate of the fast and slow conducting pathways were examined. In 1 of the 4 cases with AVRT, DARs were observed during programmed and rapid ventricular pacing, performed during sinus rhythm and also during entrainment. In 1 of the 4 cases with AVNRT, DARs were observed only during entrainment. The determinants of DARs in cases with long RP' tachycardia were: (1) presence of two different retrogradely conducting pathways; (2) short ERP of the retrograde fast and slow conducting pathways and a short minimal pacing cycle length at which 1:1 ventriculoatrial conduction occurs via these pathways; (3) crucial conduction delay in the slow conducting pathway: and (4) preexisting antegrade unidirectional block in the slow conducting pathway or the antegrade block in the slow conducting pathway produced by collision with a previous retrograde impulse during entrainment.     

Studies on Serum Gastrin of the Patients with Gastric Cancer

In patients with gastric cancer who were to undergo gastrectomy, the fasting serum gastrin concentration in the peripheral vein was estimated by radioimmunoassay. The blood samples were also collected from the gastric veins and artery during the time of operations. These gastrin values were compared with morphological findings in the resected stomach.
No significant differences in serum gastrin concentration was found between the patients of gastric cancer and normal subjects. In the patients with mucosal atrophy in the oxyntic gland area but with no atrophy in the pyloric gland area, however, significant increase in serum gastrin concentration was observed. In cases where fundal atrophy was accompanied by atrophy in the pyloric gland area, the increase was not observed. The amount of gastrin content in cancer tissue was negligible.
These results indicate that the increase in serum gastrin concentration in some patients with gastric cancer might be due to the accompanied atrophy of oxyntic glands in the stomach.     

Acute pancreatitis complicating typhoid fever in a 4-year-old girl

Pancreatitis represents an extremely rare complication of typhoid fever. Herein we report the case of a 4-year-old Bangladeshi girl with acute pancreatitis caused by Salmonella typhi.     

Effect of Atrial Natriuretic Peptide on Electrical Defibrillation Efficacy

ANP and Defibrillation. Introduction : In vitro studies have suggested that human atrial natriuretic peptide (ANP) modulates the electrophysiologic properties of myocardial cells. This study assessed whether ANP could influence defibrillation efficacy.
Methods and Results : In 35 anesthetized dogs, the transcardiac defibrillation threshold (DFT) as well as hemodynamic and electrophysiologic variables were determined before and during treatment with ANP (n = 11), hydralazine (n = 11), or saline (n = 13). ANP (1.5 μg/kg + 0.2 μg/kg per min) increased the plasma concentration of cyclic GMP (a second messenger for ANP) and significantly decreased aortic blood pressure (mean 100 ± 11 mmHg to 83 ± 15 mmHg). ANP also prolonged ventricular repolarization (effective refractory period 157 ± 7 msec to 165 ± 11 msec) and markedly reduced DFT (5.4 ± 1.2 J to 3.8 ± 0.7 J [P < 0.01]) without changing pulmonary artery pressure or sinus cycle length. Neither saline nor hydralazine (1.5 mg/kg) had a significant effect on DFT (saline 4.7 ± 2.1 J to 4.6 ± 2.4 J; hydralazine 4.3 ± 2.0 J to 4.2 ± 1.9 J), although hydralazine caused pronounced hypotension (mean aortic pressure 103 ± 9 mmHg to 74 ± 13 mmHg).
Conclusion : These results suggest that ANP increases defibrillation efficacy, and that this effect is not necessarily shared by other vasodilating agents.     

Effect of Radiofrequency Catheter Ablation on Parasympathetic Denervation: A Comparison of Three Different Ablation Sites

Radiofrequency (RF) catheter ablation of supraventricular tachycardias (SVT) has been shown to result in local parasympathetic denervation. The purpose of this study was to estimate the correlation between RF cumulative energy and parasympathetic denervation at three different ablation sites. Methods: 45 patients who underwent RF ablation of 36 AV reentrant tachycardias and 9 AV nodal reentrant tachycardias were studied. Twenty patients had left free-wall accessory pathways (group L), 8 patients right free-wall accessory pathways (group R), and 17 patients septal accessory path ways (n = 8) or slow pathways (n -9)(groupS). Time and frequency domain analysis of heart rate variability on 24-hour ambulatory ECG recordings was performed before and after RF ablation, pNN50 and the high frequency (0.15 to 0.40 Hz, HF) component were measured to examine the effects on parasympathetic nerve activity. The values of Δ pNN50 and Δ HF were expressed as the percent change of pNN50 and HF that occurred after versus before RF ablation. Results: Both pNN50 and HF significantly decreased after RF ablation in all three groups. In group S, there was a significant correlation between RF cumulative energy and Δ pNN50r = 0.66, P < 0.01) or Δ HF (r = 0.58, P < 0,05). In contrast, there was no correlation between RF cumulative energy and Δ pNNSO or Δ HF in either group L or group R. Conclusion: These data suggest that RF ablation produces parasympathetic denervation at all three sites along the mitral or tricuspid annulus and that parasympathetic fibers may be located predominantly in the septal area.