ENDOSCOPIC MANAGEMENT OF A DIEULAFOY‐LIKE LESION IN A DUODENAL DIVERTICULUM

We present a 70‐year‐old man who had two episodes of melena during the preceding 8‐year period. He had a Dieulafoy‐like lesion in a diverticulum in the third portion of the duodenum. While emergency endoscopy revealed neither apparent blood nor clots around the diverticular orifice, there was a non‐bleeding vessel in the fundus of the diverticulum. The vessel ceased bleeding after argon plasma coagulation and, since then, the patient has not experienced bleeding. In cases of gastrointestinal bleeding of obscure origin, duodenal diverticulum should be considered as a possible source of bleeding, even when endoscopy discloses no apparent bleeding.     

Hypoplasia of the humeral trochlea

Radiographic studies of three cases of hypoplasia of the humeral trochlea were done. Several other anomalies were also detected, including a hypoplastic capitellum in case 2, a hyperplastic radial head in cases 2 and 3, and bulging of the loose joint capsule in case 3. Operations in cases 1 and 3, disclosed that ganglions and fibrous septa compressed the ulnar nerve. The cause of ulnar nerve palsy in patients with hypoplasia of the humeral trochlea is thought to be associated with the high incidence of ganglions in hypoplastic elbow joints. The ganglion may play a role.     

Clinical studies on a newly devised amino acid solution for neonates

In 97 neonates receiving total parenteral nutrition in the postoperative period, clinical assessment was made for a newly devised amino acid solution (PF-I-III) from the standpoint of plasma amino acid profile and nutritional effect. These amino acid solutions prepared are characterized by the high concentration of branched-chain amino acids up to 40%, increased arginine and decreased glycine, phenylalanine and methionine as compared with commercially available solutions. In the PF group, each amino acid was kept within the range of standard value. Correlation between plasma amino acid profiles and the dose of each amino acid administered was obtained, from which minimum, standard, and maximum doses for each amino acid was determined. Based on these values, we proposed new formula for neonates which elicits no abnormal plasma amino acid pattern even when amino acids are administered at the dosage level of 1.5-2.5 g/kg/day.     

Musculocutaneous grafts with draining vein: an experimental study

Venous drainage of a musculocutaneous graft was shown to be of importance for the prevention of necrosis and successful graft take. An experimental model was provided in which the iliolumbar veins were used as draining veins in creating musculocutaneous grafts 4 X 3 cm and 4 X 6 cm in size. In the study, it was demonstrated that necrosis could be prevented by preserving draining veins. The number and size of these veins were of some significance in the survival of the grafts.     

An Experimental Study on the Relationship Between Artificial Korotkoff Sounds and Self-Excited Oscillation Using a Circulatory Simulator

In the medical field, Korotkoff sounds have been explained as sounds generated by the disturbed blood flow in the artery. However, in the biomechanics field, Korotkoff sounds are considered to be produced and/or modified by the self-excited oscillation of a collapsed artery. The self-excited oscillation is an oscillation of the arterial wall. In addition, it is influenced by the nonlinear pressure–flow relationships in the artery and the arterial compliance. In this paper, we proposed an arterial-compliance-measuring method, using Korotkoff sounds. We constructed a circulatory simulator with a brachial model that mimics the physiological circulation, because in vivo resolution of nonlinear pressure–flow relationships is very difficult. The simulator was utilized to generate artificial Korotkoff sounds similar to those in auscultation in the brachial model. Additionally, we prepared latex tubes as artificial brachial arteries. In the experiment, we investigated the relationship between the self-excited oscillation and Korotkoff sounds by the distinguishing its frequency characteristics. The frequency of the sounds was changed by the variation of the tube compliance. As a result, we have found that the changes of the sounds largely depended on the difference of the tube compliance in this simulator. In conclusion, Korotkoff sounds contain useful information for predicting brachial arterial compliance. These experiments indicate the effectiveness of noninvasive measurement for brachial arterial compliance using Korotkoff sounds.     

Effect of central scotomata on pattern reversal visual evoked potentials in patients with maculopathy and healthy subjects

The effect of central scotomata on pattern reversal visual evoked potential (PVEP) was investigated in patients with maculopathy and healthy subjects. PVEP was evoked monocularly by both full-field and half-field stimulations. Since the latency of 'the major positivity at Oz' (P100-Oz) is used as the most reliable parameter in the clinical application of PVEP, special attention was focused on its changes, comparing with 'ipsilateral major positivity of half-field PVEP' (P100-IHF). Although the incidence of modification was lower in the patients, central scotomata modified PVEPs of the healthy subjects and of the affected eye of the patients in a similar manner: full-field PVEP showed prolonged latency and reduced amplitude of P100-Oz. Half-field PVEP disclosed prolonged P100-Oz latency with intact P100-IHF latency. Only difference was that amplitude reduction of both P100-Oz and P100-IHF of half-field PVEP was observed only in the healthy subjects. The prolonged P100-Oz latency of half-field PVEP was accompanied, both in the healthy subjects and in the patients, by a contralateral negative-positive complex (N105-P135) which was augmented and extended to Oz. The prolonged P100-Oz latency, thus, was due to the pronounced P135. These observations suggested that an attenuation of the afferent impulses from the central retina may cause a prolongation of the P100-Oz latency in both healthy subjects and patients, but this is not a reflection of the truly prolonged P100-IHF latency. It was concluded that, in the clinical application of PVEP, recordings of half-field PVEP from the lateral electrodes seem to be essential to distinguish true prolongation of the P100-Oz latency.     

Plasma volume estimation using indocyanine green with biexponential regression analysis of the decay curves

We studied seven analytical methods of estimating the plasma volume from the decay curves of indocyanine green. Fifteen volunteers received 1.0 mgkg⁻¹ of the dye by intravenous injection and the plasma concentration was measured continuously using spectrophotometry. Plasma volumes were calculated using three single-regression methods (1-a, 1-b, 1-c) and four biexponential regression methods (2-a, 2-b, 2-c, 2-d). The means (SD) of 1-a, 1-b and 1-c were 39 (5.0), 44 (5.7) and 54 (11.5) mlkg⁻¹, respectively, and these were significantly different from each other (p < 0.05). The values for methods 2-b, 2-c and 2-d were similar to each other: 39 (4.6), 40 (4.1) and 40 (4.0) mlkg⁻¹, respectively. These required more than 3 min circulation or mixing time. When the time allowed for mixing was less than 3 min (method 2-a) the plasma volume was underestimated. We conclude that plasma volume estimation using indocyanine green and spectrophotometry is most accurate when the mixing time is adequate (3–5 min) and the decay curves are analysed using biexponential regression.     

Surgical Treatment of Intractable Seizures Due to Hypothalamic Hamartoma

Summary: A 6.5-year-old boy developed seizures at age 2.8 years consisting of episodes of unconsciousness and laughing attacks. By age 6 years, multiple seizure types, including generalized tonic-clonic (GTC), complex partial (CPS) and akinetic seizures, and drop attacks were occurring several times daily. EEG showed multifocal epileptic discharges. Antiepileptic drugs (AEDs) did not control the seizures. With progression of the epilepsy, cognitive deterioration developed. There were no manifestations of precocious puberty. Neuroimaging disclosed a suprasellar mass in continuity with the hypothalamus, and a diagnosis of hypothalamic hamartoma was made. After surgical resection of the hamartoma, the seizures were completely alleviated, and the epileptic EEG discharges disappeared. Improvement of mental function was also noted.     

A prostacyclin analogue reduces free radical generation in heart-lung transplantation.

The mechanism by which prostacyclin acts to prevent in vivo reperfusion injury is still uncertain. This study was therefore undertaken to assess the effect of a stable prostacyclin analogue (OP 41483-alpha-CD [OP]) on oxygen-derived free radicals after heart-lung transplantation. OP was administered to the heart-lung graft through the pulmonary artery for 25 minutes encompassing the reperfusion process. Free radicals were directly measured by electron spin resonance spectroscopy. The radical intensities of pulmonary venous blood were significantly lower in the OP group than in the control group, suggesting that fewer free radicals were generated in the lungs of the OP group. The cardiac and respiratory function were better in the OP group than in the control group. The lung is the primary source of oxygen free radical attack, and the beneficial action of OP on free radical generation is almost exclusively restricted to the lung and does not apply to the heart. This result suggested that OP probably is effective in inhibiting free radical generation from the endothelium.