A Clinical Study on Colitis Found during Total Colonoscopy Screening for Colorectal Cancer

Abstract: Colitis was found in 302 out of 5803 patients (5.2%) who underwent colonoscopy for the first time. Unclassified colitis (with slight edema, hemorrhage etc.) accounted for 89.1 % of these cases. Most of the colitis (93 cases, 40.1 %) was found to affect the sigmoid colon, followed, in order of decreasing frequency, by the rectum, cecum, transverse colon, descending colon and ascending colon. A comparison of the percentage revealed that of colitis found in two groups which were given different pre-treatments, 80 out of 3280 cases (2.4%) were found among those examinees pre-treated by the modified Brown method (B-method), while 152 out of 2513 cases (6.0%) were found in those pre-treated by the PEG oral lavage method (P- method). About 40% of the diagnosed colitis cases were free from symptoms (diarrhea, abdominal pain, etc.); the results of the guaiac test on their stool samples were negative. We hypothesized that, in these cases, signs of colitis were actually pretreatment-induced artifacts. No significant differences were found among groups with regard to sex and age, nor was the fraction of colitis cases represented by artificial colitis significantly different between pre-treatment groups.     

Oral contraceptive-dependent growth of focal nodular hyperplasia

Abstract A 22 year old woman was incidentally found to have a hepatic small haemangioma-like mass, measuring 1.4 cm in diameter, by an ultrasonographic examination. The mass demonstrated no change in size or appearance for 6 months until the patient began to take oral contraceptives. Eventually, the mass increased to 2.0 cm in diameter after using oral contraceptives for 6 months. A histological examination suggested the mass to be typical focal nodular hyperplasia, and not hepatic adenoma. There was no further change in either size or appearance in the ensuing 1 year after the discontinuation of oral contraceptives.     

Bronchial hyper-responsiveness to inhaled histamine in children with congenital heart disease

In order to assess bronchial responsiveness in patients with congestive heart failure secondary to congenital heart disease, we performed a histamine inhalation test while monitoring transcutaneous oxygen tension and compared the respiratory threshold to histamine with that obtained in patients with bronchial asthma. The inhalation test was performed by doubling concentrations of histamine solution for 2 min at 1 min intervals. The respiratory threshold of histamine was defined as the minimal concentration causing a drop in transcutaneous oxygen tension greater than 10% from baseline. Six of 10 patients with congenital heart disease and all of 12 patients with bronchial asthma had bronchial hyper-responsiveness to histamine. The mean of histamine concentration was 2750μg/mL and 937μg/mL, respectively. During the histamine inhalation test, respiratory resistance gradually increased in congenital heart disease patients. This was measured by the linear slope of transcutaneous oxygen pressure (-1.08 ± 0.75 mmHg/min), whereas in the bronchial asthma patients it rapidly decreased at the inflection point (-4.19 ± 1.86 mmHg/min). We conclude that children with congestive heart failure had bronchial hyper-responsiveness. We suggest bronchial hyper-responsiveness to inhaled histamine in congestive heart failure was caused by the gradual increased respiratory resistance, which was different from that of bronchial asthma.     

Comparison of Arrhythmogenicity of Atrial Pacing at Several Right Atrial Pacing Sites: Evaluation of Canine Atrial Electrograms During Atrial Pacing and Arrhythmogenicity for Atrial Fibrillation

The changes in the duration of atrial electrograms and the appearance of AF during atrial pacing were compared among five atrial pacing sites in dogs to clarify the arrhythmogenicity of atrial pacing at different atrial pacing sites. In seven mongrel dogs (15–20 kg), the right atrial surface was exposed by right thoracotomy. Atrial electrograms were recorded via bipolar electrodes with an interelectrode distance of 1.2 mm at four right atrial sites: (1) the high right atrium (HRA), (2) the mid-right atrium (MRA), (3) the low right atrium (LRA), and (4) the center of the pectinate muscle (PM). The duration of the atrial electrograms at these four recording sites were measured during atrial pacing with fixed cycle lengths of 200, 150, and 120 ms delivered at five atrial sites: (1) the HRA, (2) the inferior vena cava (IVC), (3) the right atrial appendage (RAA), (4) Bachman's bundle (BB), and (5) the atrial septum (AS). In each dog, the atrial pacing with the 120-ms cycle length was performed five times at each pacing site to evaluate the in-ducibility of AF. When AF was induced, the atrial recording site which first showed a fragmented atrial electrogram was considered the initiation site of the AF. AF was induced during 9 of 35 episodes of atrial pacing at the HRA site, 11 of 35 at the IVC site, 5 of 35 at the RAA site. 3 of 35 at the BB site, and none at the AS site. The initiation site of AF was in the HRA site in 11 of 28 episodes of induced AF, in the MRA site in 9 of 28, and in the LRA site in 8 of 28. At each recording site, the shorter the paced cycle length, the longer the duration of the atrial electrogram regardless of the pacing site. During the atrial pacing with the 200-ms cycle length, the HRA pacing resulted in the shortest duration of the atrial electrogram at each recording site in comparison with the other pacing sites. However, during atrial pacing at the two shorter paced cycle lengths, the duration of the atrial electrogram was shorter during the pacing at the BB or AS sites in comparison with the other three pacing sites, i.e., the HRA, IVC, and RAA sites. These results were the same for all atrial recording sites, but the prolongation of the atrial electrogram was most prominent at the HRA and MRA recording sites, which are most likely initiation sites of the induced AF. In the canine atria, (1) the initiation sites of AF were likely to be the HRA, MRA, or LRA sites in comparison with the PM site; and (2) the atrial pacing at the BB or AS sites was considered less arrhythmogenic for AF than the pacing at the HRA, LRA, or RAA sites.     

Influence of Mobile Magnetic Resonance Imaging on Implanted Pacemakers

KISHI, R., et al.: Influence of Mobile Magnetic Resonance Imaging on Implanted Pacemakers. Purpose: Mobile magnetic resonance imaging (MRI) systems will be widely used in Japan. When traveling, mobile MRI generate alternating electromagnetic waves which may cause electromagnetic interference (EMI). This study was designed to determine whether this may influence the function of implanted pacemakers (PM). Methods and Results: The influence of the static magnetic fields was tested in the first method using a PM-human model (Phantom). Magnetic force was simultaneously measured. The PM was switched to the magnet mode within 90 cm from the vehicle, where the magnetic force was = 2 mT. In the second method, six phantoms were placed on the side of the road, facing in three different directions in X-Y-Z axis orientations, at 1.3 m and 2.0 m above the ground. The mobile MRI passed by at a distance of 1 m from the phantoms at the speed of 20 or 40 km/h. In these experiments, magnet mode switch of the PM was observed for 2 seconds when the vehicle passed close to the phantoms, though no electrical noise was recorded. Conclusion: Mobile MRI vehicles can switch a PM to magnet mode when the distance between patient and vehicle is <90 cm, regardless of whether the vehicle is moving or at a stop. Patients with implanted PM should not approach within <1 m of a mobile MRI. No other EMI-induced PM dysfunction was detected. (PACE 2003; 26[Pt. II]:527–529)     

Adiponectin is increased and correlated with the degree of proteinuria, but plasma leptin is not changed in patients with chronic glomerulonephritis

Aim:   Altered regulation of adiponectin and leptin may be relevant to endothelial dysfunction and cardiovascular complications in patients with chronic glomerulonephritis.
Methods:   The relationship between the levels of plasma adiponectin, leptin and proteinuria, glomerular filtration rate and metabolic risk factors was investigated in 38 patients with chronic glomerulonephritis.
Results:   Plasma adiponectin was much higher in patients with heavy proteinuria (38.8 ± 27.8 µg/mL) than in patients with mild proteinuria (13.3 ± 5.1 µg/mL, P  < 0.001) and with moderate proteinuria (18.1 ± 8.0 µg/mL, P  < 0.01). The levels of serum leptin were not changed among these groups. Proteinuria and lipoprotein(a) were a strong and direct correlate of plasma adiponectin ( r  = 0.75, P  < 0.0001), while serum albumin and the glomerular filtration rate correlated inversely with this protein ( r  = −0.56, P  = 0.0002; r  = 0.38, P  = 0.02). Body mass index and triglyceride were direct correlates ( r  = 0.37, P  = 0.02 and r  = 0.37, P  = 0.02, respectively) of plasma leptin in patients with glomerulonephritis.
Conclusions:   Plasma adiponectin but not plasma leptin levels correlate with proteinuria in patients with chronic glomerulonephritis.     

Autoantibodies against a 210kDa glycoprotein of the nuclear pore complex as a prognostic marker in patients with primary biliary cirrhosis

It has been reported that the presence of anti-nuclear antibody against a 210kDa glycoprotein of nuclear pore complex (anti-gp210) is highly speci?c for primary biliary cirrhosis (PBC). The aim of the present study was to investigate the signi?cance of anti-gp210, especially as a prognostic marker. The presence of anti-gp210 was ascertained in 113 patients with PBC and 162 controls by indirect immuno?uorescence assay using HepG2 cells and immunoblotting analysis using nuclear extracts from HeLa cells. Anti-gp210 was detected in 25 of the 113 (22.1%) patients. None of the 162 controls was positive for anti-gp210. The appearance and titre of anti-gp210 in the patients with PBC did not vary from the time of diagnosis and through their clinical course. Anti-mitochondrial antibodies (AMA), including antibodies against pyruvate dehydrogenase complex, branched chain α-ketoacid dehydrogenase complex and α-ketoglutarate dehydrogenase complex, were not detected by enzyme-linked immunosorbent assay in ?ve of the 113 (4.4%) patients with PBC. However, anti-gp210 alone was positive in one of these ?ve patients. The difference in prognosis was statistically signi?cant; patients with PBC positive for anti-gp210 died from hepatic failure more frequently than those who were negative (P < 0.01), although there were no statistically signi?cant differences in the frequency of jaundice and the histological stage at the time of diagnosis between the two groups. We suggest that the presence of anti-gp210 is one of the independent prognostic markers able to predict, at the time of diagnosis, a poor outcome in patients with PBC.     

Differences in Fine Mucosal Structure between Superficial Spreading Carcinoma and Non-neoplastic Bile Duct Mucosa Detected by Percutaneous Transhepatic Cholangioscopy

Abstract: Papillogranular mucosa is reportedly characteristic of superficial spreading bile duct carcinoma, but may also be seen in non-neoplastic ductal tissue. This study was designed to clarify differences between these conditions by examining fine mucosal structure with percutaneous transhepatic cholangioscopy (PTCS) and methylene blue (MB) staining. Sixty-three patients with malignant bile duct stenoses and 11 with benign bile duct disorders were examined by PTCS and the relationship between fine mucosal structure and histology was defined using endoscopic photographs and biopsy samples. Papillogranular mucosal samples contained superficial spreading carcinoma significantly more often than smooth mucosal samples (p<0.0001). Papillogranular mucosa was classified by fine structure into four types : regular papillogranular, nodular, finely reticulogranular and highly papillary. The latter three types were associated with superficial spreading carcinoma significantly more often than with non-neoplastic mucosa (p<0.05). However, regular papillogranular mucosa was associated with both neoplastic and non-neoplastic tissue. All papillogranular mucosal samples not stained with MB contained superficial spreading carcinoma. In 19% of papillogranular mucosa samples fine mucosal structure was identified by routine observation, while in 84% fine structure was determined by a combination of routine observation and MB staining. In conclusion, nodular, finely reticulogranular and highly papillary forms of papillogranular mucosa, as well as papillogranular mucosa which does not stain with MB, are characteristic of superficial spreading carcinoma. The combination of routine observation and MB staining is useful for analyzing the fine mucosal structure of papillogranular mucosa. However, meticulous observation is needed to diagnose superficial spreading carcinoma in regular papillogranular mucosa.