Sudden death from metastatic esophageal cancer to the ventricular septum.

A 67-year-old man was admitted to our hospital due to esophageal cancer. Cancer existed at the lower esophagus and subtotal esophagectomy and lymphadenectomy was performed. The postoperative course was uneventful. Pathological findings revealed moderately differentiated squamous cell carcinoma that metastasized to the abdominal lymph nodes which include the paraaortic lymph nodes. He complained of anorexia three months after the operation and was found to have multiple liver and mediastinal lymph node metastases. He was admitted for chemotherapy. Before starting chemotherapy, he suddenly died without any sign of hemorrhage or respiratory disorder. Autopsy showed metastatic lesions to the heart and mediastinal lymph nodes, liver, thoracic vertebrae, kidney, adrenal gland and heart. Metastatic nodules in the heart were on the ventricular septum where the conducting system exists. No direct invasion from the pericardium was observed. Blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.     

Response of capsaicin pretreated skin blood vessels to exercise

Six normal men performed cycle ergometer exercise from 50 W to 125 W in a room maintained at 26 degrees C. Capsaicin was introduced by iontophoresis into the forearm skin. Forearm skin blood flow (FSBF) during graded exercises before and after capsaicin treatment was measured by laser Doppler flowmetry. Forearm skin blood flow before capsaicin treatment increased depending on the intensity of exercise. However, forearm skin blood flow 24 hours after capsaicin treatment scarcely increased during graded exercise. The cause of this capsaicin effect was discussed.     

Traumatic acute subdural hygroma mimicking acute subdural hematoma.

Subdural hygroma is a frequent delayed complication of head trauma. Most hygromas are clinically 'silent' and a few cases have shown slow deterioration in the chronic stage. We report a case of subdural hygroma showing unique radiological findings and rapid deterioration. A 74-years-old female presented with a mild headache and consciousness disturbance after head injury. Computed tomography showed a midline shift as a result of two components piling up in the subdural space; the outer components showed low density, the inner components high density. Magnetic resonance imaging demonstrated that these two subdural components were subdural hygroma and subarachnoid hematoma. Simple burr hole irrigation, rather than large craniotomy, was thought to be more appropriate treatment to reduce the mass effect. Simple burr hole irrigation was performed to remove the subdural hygroma and the patient showed an excellent recovery. Careful examination of the radiological findings prevented an unnecessary procedure in this case. A possible mechanism of this phenomenon is discussed.     

Remote Connection to the Kyushu University Medical Center LAN Using Digital and Analog Telephone Lines

SOHO (Small Office/Home Office) has recently become popular, as it makes working at home possible. Computers or Local Area Networks(LAN) connected to the office network from home are necessary for the implementation of this concept. Kyushu University has begun a service connecting home computers to the campus LAN for researchers, staff and students of the Faculty of Medicine. We have two different telephone connection methods. One connects the campus LAN and the home computer LAN using routers through the Integrated Services Digital Network (ISDN). The other connects computers at home to the workstation in the university, using modems and the PPP (Point to Point Protocol) through a public telephone analog line. This paper outlines our university SOHO connection system and discusses the merits and demerits of using telephone line connections.     

Diurnal changes in colonic motility in conscious dogs

Daily profile of colonic motor activity was observed in 10 conscious dogs by means of extraluminal force transducers. Each dog was implanted with a set of seven strain, gauges, one on the terminal ileum and the remaining six on the colon equidistantly. The colonic motor activity was basically composed of migrating and non-migrating motor complexes at all six recording sites. Each motor complex was characterized by a tonic contraction superimposed by rhythmic bursts of phasic contractions. During fasted period these motor complexes recurred at a mean interval of 36 min, and a mean duration was 7 to 12 min. Those motor complexes which migrated over at least three recording sites were defined as "migrating", 72% of those observed at the most proximal sites (n = 2680) were migrating, and the remaining 28% were non-migrating. Of those migrating motor complexes 90.4% migrated caudad (iso-peristalsis), while only 9.4% migrated orad (antiperistalsis). During postprandial period the colonic motor complexes at all recording sites uniformly increased their frequency with shorter intervals. Different from the small intestine, the contractile patterns were essentially the same as those of fasted period. The postprandial acceleration of the colonic motor complexes seems to be compatible with gastrocolic response.     

Relationship between HLA-D and in vitro and in vivo responsiveness to Candida allergen.

In vitro reaction to Candida allergen was studied in 100 normal healthy Japanese and related to HLA. A significant association was found between the low responder group (< 7,000 c.p.m.) and HLA-B15 and the high responder group (> 7,000 c.p.m.) and HLA-B7, as well as Dwl. Four HLA-D homozygote cells of types HLA-Dwl and DHO, were tested; these fitted in the high responder group. HLA-DYT and DEn fitted into the low responder group. Responsiveness to Candida allergen corresponded to skin test (r = 0.884, P < 0.01). From these results, in vitro lymphocyte reaction to Candida allergen and skin tests showed close correlation and an association with HLA antigens, HLA-D in particular.     

In-phantom two-dimensional thermal neutron distribution for intraoperative boron neutron capture therapy of brain tumours

The aim of this study was to determine the in-phantom thermal neutron distribution derived from neutron beams for intraoperative boron neutron capture therapy (IOBNCT). Gold activation wires arranged in a cylindrical water phantom with (void-in-phantom) or without (standard phantom) a cylinder styrene form placed inside were irradiated by using the epithermal beam (ENB) and the mixed thermal-epithermal beam (TNB-1) at the Japan Research Reactor No 4. With ENB, we observed a flattened distribution of thermal neutron flux and a significantly enhanced thermal flux delivery at a depth compared with the results of using TNB-1. The thermal neutron distribution derived from both the ENB and TNB-1 was significantly improved in the void-in-phantom, and a double high dose area was formed lateral to the void. The flattened distribution in the circumference of the void was observed with the combination of ENB and the void-in-phantom. The measurement data suggest that the ENB may provide a clinical advantage in the form of an enhanced and flattened dose delivery to the marginal tissue of a post-operative cavity in which a residual and/or microscopically infiltrating tumour often occurs. The combination of the epithermal neutron beam and IOBNCT will improve the clinical results of BNCT for brain tumours.     

Sequence analysis of the germ-line VH gene corresponding to a nephritogenic antibody in MRL/lpr lupus mice.

In order to investigate the genetic origin of nephritogenic antibodies in MRL/Mp-lpr/lpr (MRL/lpr) lupus mice, we isolated the germ-line heavy chain variable region (VH) gene corresponding to the nephritogenic antibody, B1, derived from an unmanipulated MRL/lpr mouse. Injection of this antibody into C.B-17/Icr-scid/scid mice resulted in the generation of wire loop-like glomerular lesions resembling those of lupus nephritis. Nucleotide sequences of this germ-line VH gene showed no replacement mutation in the VH region of the B1 antibody. Furthermore, this gene was identical to that found in the C3H/HeJ-lpr/lpr strain of mice. Our results suggest that germ-line VH genes can encode nephritogenic antibodies without somatic mutation, even in a mouse strain not prone to lupus.