Two Cases of Hepatectomy for Leiomyosarcoma Metastasized to the Liver

The literature reports five major hepatic resections for metastaticleiomyo-sarcomas. Two cases of jejunal leiomyosarcoma metastasizedto the liver are now reported. In the first case a successfulright hepatic trisegmentectomy was performed, 2 yr after removalof the primary lesion. In the second case a right hepatic bisegmentectomywas performed one month after resection of the primary tumor.The patient survived 21 months.     

Identification of the Slow Conduction Zone in Idiopathic Left Ventricular Tachycardia

The mechanism of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) is considered to be reentry. However, the nature of the reentry circuit, including the location of the slow conduction zone, is unclear. We sought the local electrical activity that would reflect slow conduction by precise mapping around the tachycardia exit (TE) in nine patients with ILVT (mean age, 28 ± 10 years) undergoing radiofrequency catheter ablation (RFCA). The TE was defined as the earliest discrete spiky potential (SP) recorded during the tachycardia, or as a complete configuration-matched pacemap 12-lead electrocardiogram (ECG). In all patients, the TE was located at the mid or inferior distal portion of the septum. The SP at the TE preceded the surface QRS by 20 ± 9 ms. The pacemap score at the TE was 11.4 ± 0.6 points. In three patients, fractionated potentials (FP) were recorded during the tachycardia. The onset of the FP preceded the surface QRS by 47 ± 8 ms and was earlier than the SP at the TE (P < 0.01). The sites where an FP was detectable were restricted to a small area, and were at a distance of 14 ±4 mm from the TE. The direction of the FP site from the TE was more basal in two patients and inferior in one, Pacemap ECGs at the sites with an FP showed poor matching (9 ± 1 points), presumably because of predominant capture of the local ventricular muscle rather than an electrically isolated reentry circuit. Successful RFCA was achieved at the site of the FP in all three patients in which one was recorded, and at the TE in the other six patients. The FP, which has been shown to reflect the slow conduction of the ventricular tachycardia circuit in structural heart disease, was also detected in ILVT in the present study, and it is likely to reflect electrical excitation of the distal rim of the slow conduction zone.     

Six month outcomes of an innovative weekly intergenerational day program with older adults and school‐aged children in a Japanese urban community

Aim: To describe the nature of the progression of intergenerational interactions among and between older people and children in a weekly intergenerational day program (IDP) in an urban community and to evaluate the older people's health‐related quality of life (HRQOL) and depressive symptoms, compared to the program volunteers, as well as the children's perspectives of older people, during the first 6 months of the program's implementation. Methods: This longitudinal study, with a convenience sample of older people (n = 14), program volunteers (n = 8), and school‐aged children (n = 7), used mixed methods to analyze the results. Participant observations and interviews were used to describe the interactions between the generations over the 6 months. An ANOVA with repeated measures was used to determine the statistical effects over time (initially and at 3 months and 6 months) for HRQOL (Medical Outcomes Study 8‐Item Short‐Form Health Survey) and depression (Geriatric Depression Scale, GDS‐15). Semantic differential scales identified the children's perspectives of older people. Results: The intergenerational interactions were grouped into thirteen categories; for example, “The IDP provided a meaningful sense of place.” The quality of life in relation to the mental health of the older people's group improved significantly between the first involvement and after 6 months, while the GDS‐15 scores significantly decreased at the three time points in the more depressed older people's subgroup. The children's initial generally positive perspectives of older people showed no statistically significant change over time. Conclusion: The intergenerational interactions in the IDP yielded a meaningful place for both generations, improved the HRQOL of the older people's group, and decreased the depressive symptoms in the more depressed older people's subgroup.     

Long-term Survival of Diffuse Large B Cell Lymphoma of the Trigeminal Region Extending to the Meckel's Cave Treated by CHASER Therapy: Case Report

A 52-year-old man with a history of malignant lymphoma of the cecum presented with lancinating facial pain in the left. Magnetic resonance imaging (MRI) revealed a tumor in the Meckel''s cave extending along the trigeminal nerve. The tumor was partially removed via left retrosigmoid lateral suboccipital craniotomy. Histological examination showed findings consistent with diffuse large B cell lymphoma, which was later confirmed to be metastatic lesion from the cecal lesion. Postoperative chemotherapy with cyclophosphamide, high dose, cytarabine, steroid (dexamethasone), etoposide, and rituximab (CHASER) followed by whole brain irradiation (30 Gy) resulted in complete remission. Although facial pain persisted, the patient''s general condition remained favorable and he did not experience recurrence over the 51 month follow-up period. Histological confirmation and awareness of malignant lymphoma are very important to determine the therapeutic strategy and to avoid misdiagnosis or delayed diagnosis. Long-term survival of patients with metastatic malignant lymphoma in the Meckel''s cave extending along the trigeminal nerve was very rare. In addition, metastatic malignant lymphoma in the extra-axial and peripheral nervous tissue might be different from primary central nervous system lymphoma in the white matter, since the efficacy of chemotherapeutic agents against malignant lymphomas in the extra-axial regions is not attenuated by the blood brain barrier.     

Muscle sympathetic nerve activity during central,mixed and obstructive apnea: Are there any differences?

Abstract  We recorded muscle sympathetic nerve activity (MSNA) from the peroneal nerve during sleep in three OSAS patients who showed three kinds of apnea. During central apneas and central component of mixed apnea, bursts of MSNA appeared in high probability with almost each heart beat. During obstructive apneas and the obstructive component of mixed apneas, bursts of MSNA appeared in a cluster after the end of each inspiratory effort. Burst rate of MSNA during apnea were higher in central apneas and the central component of mixed apnea than in obstructive apneas and the obstructive component of mixed apneas. These findings indicate that activity in the sympathetic nervous system is enhanced not only in obstructive apnea but also in central and mixed apnea.     

Treatment of Malignant Neurocardiogenic Vasovagal Syncope with a Rate Drop Algorithm in Dual Chamber Cardiac Pacing

A 29-year-old man with malignant vasovagal syncope presented with episodes of abrupt loss of consciousness associated with an aura, totaling more than 10 episodes over 3 months. Holter monitoring showed cardiac arrest with a duration of 15 seconds. Oral propranolol and disopyramide therapy failed to prevent the syncope. A dual chamber pacemaker with a rate drop response algorithm successfully prevented the syncope but not the aura. There may be multifactors involved in the mechanism of this syndrome. The patient has returned to a normal active life. This rate drop algorithm is an effective therapy for the prevention of syncope in malignant vasovagal syncope.     

The Effects of N-Benzoyl-β-alanine,a New Nephroprotective Drug,on the Distribution and Renal Excretion of Enprofylline in Rats

Abstract— The effects of the new nephroprotective drug N-benzoyl-β-alanine (BA) on the disposition and renal excretion of the bronchodilator enprofylline, which is actively secreted in urine, were investigated in rats. Enprofylline was administered intravenously at a dosage of 2·5 mg kg^?1 under three different steady-state plasma BA concentrations (100,200 and 400 μg mL^?1) which were achieved by constant infusion rates. Pharmacokinetic parameters for both total and unbound enprofylline were estimated by model-independent methods. The presence of BA (400 μg mL^?1) increased the systemic clearance by 25% and the volume of distribution at steady-state by 90%. A significant increase in the dissociation constant, which is the protein binding parameter of enprofylline was observed in the presence of BA (400 μg mL^?1), indicating that BA competitively inhibits the protein binding of enprofylline. However, BA significantly decreased the systemic clearance and volume of distribution for unbound enprofylline. These results suggest that BA, the organic anion transport inhibitor, inhibits renal excretion of enprofylline with a high affinity for renal tubular secretion, although the unbound concentration of enprofylline increases with administration of BA. We conclude that BA decreases the renal tubular secretion of enprofylline probably by reducing the affinity of the tubular transport system, and that these changes have marked effects on the pharmacokinetic behaviour of enprofylline.     

Evaluation of sperm fertilizing ability using the Sperm Quality Analyzer

The Sperm Quality Analyzer is an inexpensive device which provides a quantitative estimation of sperm motility. To evaluate the fertilizing ability of human spermatozoa using a Sperm Quality Analyzer, correlations amongst the sperm motility index, the sperm penetration index (as assessed using the sperm penetration assay; SPA), and the fertilization rate in the treatment of standard IVF-ET were analysed retrospectively. The sperm motility index demonstrated a significant correlation with sperm concentration ( p  < 0.001), sperm motility ( p  < 0.001) and the motile sperm concentration ( p  < 0.001) in a total of 104 fresh semen samples from 81 men donating samples for IVF-ET. The sperm motility index also showed a significant correlation ( p  < 0.001) with the sperm penetration index in 60 patients, assessed using the SPA, before they were treated by standard IVF-ET. The correlation between the sperm motility index and the IVF-ET fertilization rate was higher than that between the sperm penetration index and the fertilization rate. The sperm motility index was classified into three categories: `poor' (sperm motility index < 80), `medium' (sperm motility index 81–160) and `good' (sperm motility index>  160). The relationships between the IVF-ET fertilization rate and each category of the sperm motility index values were also evaluated. For the three categories in the sperm motility index, the fertilization rates (76.0%) of 60 samples judged as `good' were significantly higher than those (44.2%) of 15 samples judged as `medium' ( p  < 0.001) and those (34.7%) of 13 samples judged as `poor' ( p  < 0.001). These results indicate that the Sperm Quality Analyzer provides a reliable estimation of the fertilizing ability of human spermatozoa.     

Prevalence of sleep-related respiratory disorders in 101 schizophrenic inpatients

Abstract We studied the prevalence of sleep-related respiratory disorders (SRRD) in 101 schizophrenic inpatients (64 men and 37 women) and in 48 healthy volunteers (control group:22 men and 26 women) using ambulatory pulse-oximetric devices. Those with a desaturation index (DI) 5 were classified as having SRRD. The prevalence of SRRD in the schizophrenic patients (men 21.9%, women 13.5%) was not higher than that in the control group (men 30.7%, women 13.6%). Gender difference in the prevalence of SRRD was not observed in schizophrenic group. This was probably because the schizophrenic women took an increased amount of sleeping pills. Neuroleptics were shown to be least effected on SRRD.     

EFFECTS OF PINDOLOL ON THE CARDIOVASCULAR RESPONSE TO TRACHEAL INTUBATION

Laryngoscopy and tracheal intubation often cause hypertensionand tachycardia, which may be exaggerated during rapid-sequnceinduction of anaesthesia.We was studied the efficacy pindololin attenuating the cardiiovascular responses to laryngoscopyand intubation in patients receiving pindolol 2 µg kg^–1or 4 µg g^–1 min before induction of anaesthesiain a double-blind design. The data were compared with thosefor a control group receiving saline. Each group consisted of10 patients undergoing elective surgery. Anaesthesia was inducedwith thiopentone 5 mg kg^–1 i.v. and trachea/intubationwas facilitated with vecuronium 0.2mg kg^–1 Patients receivingsaline showed a significant increase in mean arterial pressureand heart rate associated with tracheal intubation. These increasesafter tracheal intubation were reduced in pindolol 4 4 4 µgkg^–-1 treated patients compared with those of the controlgroup (P<0.05). Pindolol 2 µg kg^–1 attenuatedtachycardia in response to intubation but did not afftect hypertension.These data suggest that a bolus injection of pindololµg4 kg^–-1 is a simple, practical and effective method foratenuating cardiovascular responses to laryngoscopy and trachealintubation.