Application of Ultra Short Acting Beta Blockade (Esmolol) in Pediatric Open Heart Surgery: A Trial in Total Anomalous Pulmonary Venous Return

A bstract Background : In the repair of total anomalous pulmonary venous return (TAPVR) under cardiopulmonary bypass, esmolol, ultra short acting beta blocker, was applied to obtain low heart rate and weak ventricular contraction under mild hypothermic cardiopulmonary bypass. Methods : Five infants aged from 14 to 158 days with an average of 70 days, underwent a primary or palliative repair of TAPVR. The type of anomalous return was supracardiac type (2), infracardiac (2), and intracardiac (1). A primary repair was done in three for isolated TAPVR with bypass time of 65 to 76 minutes, and a palliative repair for two with complex anomalies with bypass time of 64 and 87 minutes. Results : There was one operative death from cerebral bleeding in an infant with complex TAPVR who underwent simultaneous pulmonary banding. Conclusion : This strategy seems to be applicable in pediatric cardiac surgery when aortic cross-clamping is better to be avoided and the surgery is mainly limited to the atrial level.     

Nonfunctioning endocrine tumor arising from intracranial ectopic pancreas associated with congenital brain malformation

Case report We report a case of a nonfunctioning pancreatic endocrine tumor arising from intracranial ectopic pancreatic tissue. History An 11-year-old girl was admitted to our hospital with a brain tumor. Hydrocephalus and brain malformation were apparent at birth. We first identified a mass-like lesion in the child’s brain at age 4 months. We monitored the lesion yearly by magnetic resonance imaging (MRI) until she reached age 11 years. Gadolinium-enhanced MRI showed the lesion to be a tumor, which was resected. Pathology Examination of surgical specimens revealed a mature pancreatic tissue. We also identified monotonous neoplastic cells with round nuclei and positive immunoreactivity for synaptophysin, chromogranin A, and neurospecific enolase. However, these cells were negative for pancreatic endocrine markers. We diagnosed nonfunctioning pancreatic endocrine tumor arising from intracranial ectopic pancreatic tissue. Conclusion Migrating pancreatic elements may have induced brain malformation during embryonic development and subsequently become malignant.     

Adrenocortical function in asthmatic children: low levels of adrenocortical hormones in children with persistent attacks

The existence of adrenal dysfunction in asthmatic patients remains controversial. Assessing adrenal function in these patients is difficult because of varying severity and duration of attacks and large fluctuations in the secretion of adrenocortical hormones. Total and free (unbound) levels of serum cortisol and cortisone were measured in asthmatic children and healthy controls using reversed-phase high performance liquid chromatography. The results were correlated with the severity and duration of asthma attacks. In asthmatic patients in remission, total and free concentrations of cortisol and cortisone did not differ significantly from those in healthy controls. During attacks, levels increased in proportion to the severity of the attack. These values decreased to control levels after 24 h. However, in children with attacks lasting for more than 5 days, values remained significantly decreased with no relation to the severity of the attack. Conclusion During an asthma attack, adrenocortical hormone concentrations increase in proportion to the severity of the attack but subsequently decrease with time. It is speculated that the inability to sustain an elevated cortisol level may lead to the persistent asthma attacks.     

Immunohistochemical distribution of fibronectin in the mucosa with chronic sinusitis

The distribution of fibronectin (FN) in operative specimens of maxillary sinus mucosa from 35 patients with chronic sinusitis was examined immunohistochemically. Mouse monoclonal antibody to human FN was used for the peroxidase-antiperoxidase staining technique. FN was found in most of the serous cells and in some (about 10%) of the mucous cells in the nasal glands, and also in the nasal fluid in the lumina. It was not found elsewhere, be it in the epithelial cells, the basement membrane, or the interstitial tissue, except in two patients. These results suggest that FN is produced in the nasal glands and secreted into the nasal fluid in the maxillary sinus in chronic sinusitis.     

Effect of dopamine receptor antagonist on in vivo dopamine release induced by intrastriatal perfusion with methamphetamine in freely moving rats

In order to investigate a regulatory role of dopamine receptors in drug-induced release in the striatum, we determined dopamine and its metabolites in dialysates simultaneously with behavioral observations following intrastriatal perfusion with methamphetamine using the transstriatal dialysis method in freely moving rats. Intrastriatal perfusion with methamphetamine (5, 50, 500 microM) for 40 min produced a marked increase in dopamine release and a slight reduction in 3,4-dihydroxyphenylacetic acid release. No significant changes in spontaneous motor activity were observed after methamphetamine at concentrations up to 500 microM. Methamphetamine-induced dopamine release was not affected by the selective D1-receptor antagonist SCH 23390 (1 microM), but was markedly enhanced by the selective D2-receptor antagonist sulpiride (1 microM), at a concentration that did not change the basal level. Intrastriatal pretreatment with kainic acid (1 micrograms into bilateral striata) slightly affected the dopamine release induced by methamphetamine. These results suggest that methamphetamine-induced dopamine release is regulated by both pre- and postsynaptic D-2 receptors in the striatum in vivo.     

A clinical study of testicular tumors

Fifty-eight of the 44,698 patients seen at our Department, between 1972 and 1984 had a testicular tumor. The incidence rate was 0.13%. The mean age of these 58 cases was 28.6 years and two peak distributions, one in the 0 to 5 year and another in 26 to 30 year age group were observed. Among them, 54 patients (93.1%) had chief complaints of painless testicular swelling at initial examination. The vast majority of them had unilateral tumors; 28 in the right and 29 in the left. Only one patient had bilateral seminomas. Histologically, 30 of them (51.7%) were seminoma, 8 were embryonal carcinoma (13.8%), 2 were teratoma (3.5%) and the remaining 18 had tumors of double or multiple histological type. Most of the seminomas were treated by a combination of high orchiectomy and radiotherapy, and chemotherapy was done mainly for non-seminomatous cases. The 5-year survival rate calculated by the Kaplan-Meier method was 100% for patients with low stage (I, II) seminomas and 62% for those with non-seminomatous tumors.     

Effects of bifemelane on discrimination learning of serotonergic-dysfunction rats.

To investigate the effect of bifemelane hydrochloride on learning achievements of serotonin-deficient rats, animals were fed with tryptophan-deficient diets and operant type discrimination learning tests were performed. In general, serotonin-deficient rats show hyperactivity. In this study, total number of responses in reverse learning experiments was lower in rats that received 50 mg/kg bifemelane compared to the other serotonin-deficient groups. The ratio of correct responses to the total number of responses revealed low learning achievements in the control and low-dose groups, whereas the ratio in the high-dose group was nearly the same as in normal rats in the final few sessions of both the primary and reverse learning experiments. Throughout this study, the high-dose group showed a better improvement in learning achievement than the low-dose group. Therefore, bifemelane has certain effects on learning achievement from a) the functional activation of the serotonergic nervous system and b) changes in neurotransmitter levels in the brain (e.g., acetylcholine, noradrenaline) and overall energy metabolism.