Clinical evaluation of esophageal Doppler cardiac output measurement during general anesthesia

We evaluate the accuracy of cardiac output measurement with esophageal Doppler ultrasonography (ECO). A total of 71 simultaneous measurement of esophageal Doppler and thermodilution cardiac output were compared in 16 patients undergoing general anesthesia in the supine position. ECO was determined easily with minimal experience, and significantly correlated with thermodilution cardiac output (TDCO) measurement (P < 0.001). The regression equation obtained was Y = 0.983X + 0.019, and the correlation coefficient was 0.935. Furthermore, ECO was more reproducible than TDCO. However, ECO is not able to assess CO accurately in either lateral or prone position and after cardiopulmonary bypass in open heart surgery. Our results suggest that the esophageal Doppler technique allows a noninvasive and continuous cardiac output monitoring in patients during general anesthesia, and that it is more useful in patients for whom invasive monitoring is considered inappropriate. However, further improvement in this technique will be necessary for its routine use in clinical anesthesia.(Ueda M, Yokota S, Nakata F et al.: Clinical evaluation of esophageal doppler cardiac output measurement during general anesthesia. J Anesth 3: 178–182, 1989)     

Male elderly subthreshold depression patients have smaller volume of medial part of prefrontal cortex and precentral gyrus compared with age-matched normal subjects: a voxel-based morphometry

BACKGROUND: The brain morphological changes in subthreshold depression (sD) have not been clarified. We examined the structural difference in regional gray matter volume between community-dwelling elderly subjects with sD and age-matched nondepressed normal subjects by voxel-based morphometry (VBM) based on magnetic resonance imaging (MRI). METHODS: Thirty-four community-dwelling elderly subjects with sD and 109 age-matched nondepressed normal subjects were studied by MRI. We defined subjects with sD as those who showed a Geriatric Depression Scale score of 15 or higher and a Mini Mental State Examination score of 22 or higher, and do not fulfill the criteria of major depressive disorder (MDD) in the Diagnostic and Statistical Manual for Mental Disorders IV. We collected brain magnetic resonance images of 34 subjects with sD and 109 age-matched normal subjects, and analyzed the difference in regional gray matter volume between these two groups by VBM. RESULTS: Male subjects with sD had significantly smaller volumes of the medial part of the bilateral frontal lobes and the right precentral gyrus than normal male subjects. LIMITATIONS: We have not clarified the discrepancy in the results of gender difference. CONCLUSIONS: Our study revealed that even community-dwelling elderly male subjects with sD show bilateral prefrontal gray matter volume reduction, which was reported to be observed in elderly patients with MDD, although there is no significant volume reduction in the hippocampus, which was also reported to be observed in MDD. Our study may contribute to clarifying the mechanism underlying brain pathological changes in sD.     

Immunocytochemical and ultrastructural studies of neuronal and oligodendroglial cytoplasmic inclusions in multiple system atrophy

Summary Oligodendroglial cytoplasmic inclusions (OCI) in multiple system atrophy were investigated immunocytochemically and ultrastructurally. Among the 17 cases examined, 16 had OCIs. Almost all OCIs were positive for both B-crystallin and ubiquitin. The antibodies against tubulin, paired helical filament and tau stained OCIs to various extents. Ultrastructurally OCIs consisted of meshworks of granule-associated filaments about 25 nm in diameter that sometimes formed flame-shaped tangle-like structures. Immunoelectron microscopy showed that an epitope of B-crystallin was located on the granule-associated filaments composing OCIs. Our studies further support a cooperative role of B-crystallin, ubiquitin and cytoskeletal protein in the formation of some types of intracytoplasmic inclusions.A part of this study was presented at the 67th Annual Meeting of American Association of Neuropathologists (Baltimore, Maryland, 1991) with an abstract in J Neuropathol Exp Neurol (1991) 50: 307     

GABAergic modulation of catecholamine release from cultured bovine adrenal chromaffin cells. Evidence for the involvement of Cl−-dependent Ca2+ entry

Summary The mode by which GABA facilitates the basal and stimulation-evoked catecholamine (CA) release from cultured bovine adrenal chromaffin cells was investigated. Muscimol, a GABA_A receptor agonist, facilitated ⁴⁵Ca uptake in a concentration-related manner. When GABA and acetylcholine (ACh) were simultaneously applied, additive increase in ⁴⁵Ca uptake was observed. Similar effect on ⁴⁵Ca uptake was observed in the presence of GABA and veratridine, although ⁴⁵Ca uptake induced by a rather low concentration of veratridine was more than additively enhanced by GABA. GABA-evoked CA release was also more than additively enhanced by BayK 8644 whereas there was only an additive effect on ⁴⁵Ca uptake. Substitution of extracellular Cl^– by sucrose (low Cl^– medium) during the stimulation with GABA enhanced GABA-evoked CA release. Substitution of extracellular Cl^– for more than 1 h abolished GABA-evoked CA release and ⁴⁵Ca uptake. At this time, the concentration-response curve for veratridine-evoked CA release was shifted to left and GABA no longer enhanced veratridine-evoked CA release at any concentration of veratridine. GABA-induced facilitation of ⁴⁵Ca uptake in the presence of low concentration of veratridine was also inhibited by long-term treatment with low Cl^– medium. These results suggest that the C^–-dependent process linked to GABA_A receptor acts on voltage-sensitive Ca²⁺ channels in chromaffin cells to elicit and modulate CA release. Send offprint requests to A. Tsujimoto at the above address     

Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess the real-world 5-year treatment outcomes of ranibizumab therapy in Japanese patients with neovascular age-related...     

A Case of Cushing’s Syndrome with Multiple Adrenocortical Adenomas Composed of Compact Cells and Clear Cells

A 58-year-old woman was referred to our hospital for Cushingoid features and diagnosed as adrenal Cushing’s syndrome due to a right adrenocortical mass (60?×?55 mm). The mass was composed of three different tumors; the first one was homogeneously lipid-poor neoplasm measuring 20?×?13 mm located at the most dorsal region, the second one was heterogeneous and lipid-rich tumor containing multiple foci of calcification measuring 50?×?32 mm located at the central region, and the last one was heterogeneous harboring dilated and tortuous vessels and lipid-poor one measuring 35?×?18 mm at the most ventral region of the adrenal gland. A right adrenalectomy was subsequently performed by open surgery. Macroscopic and microscopic analyses revealed that all three tumors were adrenocortical adenomas; the first one represents a pigmented adrenocortical adenoma, the second one adrenocortical adenoma associated with degeneration, and the third one adrenocortical adenoma harboring extensive degeneration. Immunohistochemical analysis of the steroidogenic enzymes also revealed that all of the tumors had the capacity of synthesizing cortisol. This is a very rare case of Cushing’s syndrome caused by multiple adrenocortical adenomas including a pigmented adenoma. Immunohistochemical analysis of steroidogenic enzymes contributed to understanding of steroidogenesis in each of these three different adrenocortical adenomas in this case.