Long-Term Results of Cryoablation with a New Cryoprobe to Eliminate Chronic Atrial Fibrillation Associated with Mitral Valve Disease

The purpose of this study was to examine the performance of a new cryoprobe in the treatment of chronic atrial fibrillation (AF) associated with mitral valve disease. The study included 66 patients undergoing mitral valve replacement. The mean AF duration was 9.0 ± 9.0 years and mean left atrial (LA) was diameter 57 ± 10 mm. Cryoablation (−60°C) was applied to four pulmonary vein (PV) orifices over 2–3 minute. The spherical tip (2-cm in diameter) of the cryoprobe is capable of ablating the left atrium near the PV, as well as the PV ostium with a single cryoablation. After cryoablation, mitral valve surgery or a combined surgical procedure were performed in 66 patients. There were no intraoperative complications. Sinus rhythm was restored in 60 patients (91%) immediately after the operation. Recurrent AF was treated with antiarrhythmic drugs and/or direct current cardioversion in 43 patients (72%). At discharge, 48 patients (72%) were in sinus rhythm. During a mean follow-up period of 31 ± 16 months, 40 patients (61%) were in sinus rhythm with (29) or without antiarrhythmic drugs (11). In patients in sinus rhythm at the end of the follow-up period, the duration of preoperative AF duration was significantly shorter (P < 0.05) and the preoperative LA diameter and cardiothoracic ratio were significantly smaller than in patients who were in AF (both for P < 0.005). Using this new cryoprobe, sinus rhythm was restored and maintained in 61% of patients with chronic AF and mitral valve disease with a 12–15 minute cryoablation procedure.     

Steroid Therapy in IgA Nephropathy: A Prospective Pilot Study in Moderate Proteinuric Cases

Forty-three patients with IgA nephropathy whose proteinuriapersisted between 1.0 and 2.0 g/day were assessed in an uncontrolledpilot study of steroid treatment. Fourteen patients receivean initial dose of 40 mg/day of prednisolone, followed by gradualreduction of the dose over an average period of about 19 months.After discontinuation of corticosteroids, they were treatedwith non-steroid anti-inflammatory drugs and/or anti-thrombocytedrugs to the end of the study. Another 29 patients receivednon-steroid anti-inflammatory drugs and/or anti-thrombocytedrugs throughout the study. Fourteen patients treated with steroidsexperienced considerable reduction in proteinuria and maintainedrenal function over 81 months. In 29 patients treated with non-steroidanti-inflammatory drugs and/or anti-thrombocyte drugs alone,proteinuria did not decrease and renal function deterioratedsignificantly during 60 months. At the end of the study, differencesin degree of proteinuria and in levels of renal function betweenthe steroid and non-steroid groups were statistically significant.In addition, these differences became more distinct in patientswith initial creatinine clearance values 70 ml/min or more inboth groups. These results suggest that treatment with steroidsin IgA nephropathy may be beneficial, especially in the earlystage of the disease.     

New phenotype of accessory scrotum with perineal lipoblastoma: Coexistence of midperineal and lateral accessory scrotums

We present the extremely rare phenotype of an accessory scrotum with an associated lipoblastoma. There was a coexistence of midperineal and lateral types. To our knowledge, this phenotype has never been reported. The lipoblastoma, which arose in the perineum, divided the moving labioscrotal swelling into three parts during early fetal life. This resulted in the specific anomaly in this patient.     

Serum calcitonin gene-related peptide levels in untreated prostate cancer patients

BACKGROUND: The role of calcitonin gene-related peptide (CGRP) in prostate cancer has not been fully understood. Moreover, the serum CGRP level in prostate cancer patients has never been reported. We measured the serum CGRP levels in untreated prostate cancer patients to elucidate its clinical significance. MATERIALS AND METHODS: We used 36 serum samples from prostate cancer patients. All patients had never received any treatment. Serum CGRP was measured by immunoradiometric assay, and we analysed the association between serum CGRP level and clinicopathological factors. RESULTS: Serum CGRP levels in the patients with higher clinical stages and histological grade were significantly higher than in those with lower stages and grade, respectively. But the levels did not correlate with the patient's age, liver or renal functions, serum prostate-specific antigen levels. CONCLUSION: Serum CGRP levels were significantly elevated in the patients with high grade or high stage untreated prostate cancer patients. Measurement of the serum CGRP may be a useful predictor of staging or grading of prostate cancer in the untreated prostate cancer patients.     

INSULIN AND GLUCAGON SECRETION IN HEPATIC GLYCOGENOSES

ABSTRACT. Okada, S., Seino, V., Kodama, H., Yutaka, T., Inui, K., Ishida, M., Yabuuchi, H. and Seino, Y. (Department of Pediatrics, Osaka University Hospital, Fukushima-ku, Osaka and The Third Division, Department of Medicine, University of Kobe, Kobe, Japan). Insulin and glucagon secretion in hepatic glycogenoses. Acta Paediatr Scand 68: 735, 1979.—Insulin and glucagon secretion was investigated in ten patients with hepatic glycogenosis, types I and III, in order to understand the relationship between hypoglycemia and pancreatic function. In all patients, both oral glucose tolerance and intravenous arginine infusion tests revealed hypoinsulinemia. Decreased urinary C-peptide levels with standard food intake also supported hypofunction of pancreatic beta cells. On the contrary, the normal secretion pattern of glucagon in both types indicated in the arginine loading test, intact alpha cells in the pancreas. Persistent hypoinsulinism, which is apparently an adaptation to hypoglycemia, could be an important cause of nutritional dwarfism in both types of glycogenosis. The usefulness of the measurement of urinary C-peptide, which evaluates the pancreatic function and provides management for normal body growth, is discussed.     

Megacystis and megacolon in an infant with Ehlers-Danlos syndrome

We report a 14 month old male infant with Ehlers-Danlos syndrome who became ‘anuric’ due to an acutely dilated urinary bladder. Although the patient was also found to have megacolon, no diverticulum was seen in his gastrointestinal tract or urinary bladder. In order to decompress the urinary bladder and colonic wall, we put an indwelling urinary catheter in place for 2 months, and carried out daily glycerin enema for 3 months. All urological and gastrointestinal symptoms subsided with this intensive medical treatment. The diagnosis of megacystis and megacolon was made very early in life for this patient. This may indicate that the striking extension of gastrointestinal and bladder wall may lead to the development of diverticula of gastrointestinal and urinary tracts in later life.     

Interaction of Trichloroethane Isomers with Cytochrome P-450 in the Perfused Rat Liver

Interaction of Trichloroethane Isomers with Cytochrome P-450in the Perfused Rat Liver. TAKANO, T., MIYAZAKI, Y., and MOTOHASHI,Y. (1985). Fundam. Appl. Toxicol. 5, 353–360. The real-timeinteractions of 1,1,1-trichloroethane (TCE) and 1,1,2-TCE withcytochrome P-450 were observed using in vivo optical methodsto measure the spectral changes of cytochrome P-450 and thereduction-oxidation transition of pyridine nucleotides in theperfused liver of rats treated with phenobarbital. Changes inoxygen consumption and TCE uptake were also measured. The spectralchanges of cytochrome P-450 indicated that both TCE isomersbound to low spin (substrate free) ferric cytochrome P-450 andformed a high spin (substrate complexed) form. However, 1,1,1-TCEbound more tightly to cytochrome P450 and seemed to be onlyslowly metabolized compared to 1,1,2-TCE. The stoichiometryof the change in oxygen consumption rate to the change in 1,1,1-TCEuptake rate ranged between 5/1, and 9/1, whereas that of 1,1,2-TCEwas 1.4 to 2.0. Decreases in reduced pyridine nucleotides associatedwith TCE administration were significantly larger with 1,1,1-TCEthan with 1,1,2-TCE. The inhibitory effect of 1,1,1-TCE on hexobarbitalmetabolism in the perfused liver was greater than that of 1,1,2-TCE.Considering our previous data indicating that TCE did not stimulatemitochondrial respiration, it is postulated that the far higheramount of oxygen consumption associated with the binding of1,1,1-TCE to cytochrome P450 than the amount which was necessaryto mixed-function oxidation of this compound was due to an uncouplingeffect of 1,1,1 -TCE on the mixed-function oxidase system.     

Proximal-type epithelioid sarcoma of the perineum: Calling attention of urologists

A subcutaneous mass in the perineum of a middle-aged man was excised and pathologically diagnosed at first as 'undifferentiated carcinoma' of unknown origin, which recurred 2 years later without any metastasis. Further histological evaluation ultimately established a correct diagnosis of 'proximal-type epithelioid sarcoma', a variant of rare epithelioid sarcoma. This type of tumor may confuse pathologists because its histological characteristics resemble undifferentiated carcinoma or malignant rhabdoid tumor. Frequent immunoreactivity of CD34, in addition to expression of keratins, epithelial membrane antigen and vimentin, provides strong support for the diagnosis of this rare neoplasm. Urologists should be aware that this sarcoma commonly occurs in the genital regions.     

A New Pacemaker for Monitoring Asystole and Prevention of Adams-Stokes Syndrome and Sudden Cardiac Death

Patients with suspected Adams-Stokes syndrome are examined by Holter monitoring. During the monitoring, there is the danger of syncopes occurring and there are even reports of sudden cardiac death. We therefore developed a pacemaker for cardiac arrest monitoring and the prevention of Adams-Stokes syndrome and sudden cardiac death, which has the following functions: (1) the longest escape interval of the pacemaker not exceeding the value at which syncope is induced is determined by the decline of the mean heart rate including the asystole to a certain threshold rate; (2) once the pacemaker escapes from the interval it continues pacing for a while at a physiological rate to allow recover from ischemias in organs or tissues; and (3) to prevent overdrive suppression to the heart, the pacing rate gradually declines and stops pacing until the next asystole. This pacemaker is useful not only in the diagnosis of Adams-Stokes syndrome but also in pharmacological and pathophysiological studies and in determining when pacing should cease.     

Isolation and biochemical characterization of tyrosinase-rich GERL and coated vesicle in melanin synthesizing cells

The site of condensation and activation of tyrosinase prior to melanosome melanogenesis has been investigated using subcellular fractionation and enzymic analysis of so-called Golgi apparatus of melanoma cells. Two different functional units have been found in the so-called Golgi fraction, the tyrosinase-rich GERL-coated vesicle unit and the TPPase-rich Golgi unit. The tyrosinase-rich unit consists of a tubular structure with a cisternal portion corresponding to the three-dimensional structural characteristics of GERL, and spheroid vesicles, corresponding to the currently accepted criteria for coated vesicles. This fact suggests, in agreement with electron microscopic observations, that the GERL-coated vesicle unit is a specialized portion of smooth endoplasmic reticulum having the function of activating and condensing the tyrosinase synthesized by ribosomes.