A detachable balloon procedure for a traumatic internal carotid-internal jugular fistula: report of a case

A case of a traumatic fistula between the internal carotid artery and the internal jugular vein is reported. The fistula was treated by detachable balloon occlusion and clipping of the internal carotid artery.     

Cooperative phase II study of epirubicin (EPI) in bladder cancer, renal pelvic and ureteral tumors--Urological Cooperative Study Group of EPI

A phase II study of a new anthracycline anti-cancer antibiotics, epirubicin (EPI), was undertaken in 71 patients with urothelial malignancies; 40 with advanced urothelial malignancies and 31 with superficial bladder cancer. Out of them 32 patients with advanced stage of urothelial cancer were evaluated for the systemic use of EPI, while 30 patients with superficial bladder cancer for intravesical use. Intravenous administration of this new anticancer antibiotic, at a dosage of 60 mg/m2 every three weeks, showed the response rate of 20.0% for advanced bladder cancer and 14.3% for renal pelvic and ureteral tumors. In cases of superficial bladder cancer, at a dosage of 60 mg/30 ml X 3 day every week in principal, the response rate was 66.7%. Eight out of 30 patients showed complete disappearance of the tumor. Twelve patients also showed more than 50% tumor regression. As for adverse effects no serious cardiotoxicity was demonstrated. Anorexia and other gastrointestinal side effects, such as nausea and vomiting, were also seen. Alopecia and myelosuppression were the major adverse effects among patients with systemic EPI administration. With intravesical use of EPI, cystitis syndrome was the major toxicity. However, no systemic side effects were noted in these cases. In conclusion, EPI was assumed to be effective for the treatment of advanced urothelial tumors and superficial bladder cancer.     

Leptin effects on feeding-related hypothalamic and peripheral neuronal activities in normal and obese rats.

We investigated the effects of leptin on central and/or peripheral feeding-related neuronal networks in Wistar male rats either normal (350-450 g) or Zucker obese (500-800 g). Low doses (1-10 pg) of leptin inhibited glucose-sensitive vagal hepatic afferent discharges and facilitated sympathetic efferent discharges to brown and white adipose tissue. Most (40-75%) neurons in the arcuate nucleus were significantly inhibited by superperfusion with leptin (0.1 nM-10 pM) under in vitro conditions. In anesthetized animals, leptin was applied electrophoretically to single hypothalamic neurons. Both glucose-sensitive neurons (GSNs) and non-GSNs in the feeding center (LHA) were significantly inhibited. Most glucoreceptor neurons in the satiety center (VMH) were significantly excited. Their depolarization was confirmed by activation of Na+ and K+ channels by 10(-11) M leptin using the perforate blind patch-clamp method. Although leptin excited GSNs in the parvocellular part of the paraventricular nucleus, the effects of leptin on such neuronal activity were slight or absent in Zucker obese rats. These results suggest that the feeding-suppression effects of leptin are mediated by its effects on signal transduction through both the central and the peripheral nervous systems.     

Interhemispheric glioependymal cyst associated with agenesis of the corpus callosum--case report

A male neonate was admitted because prenatal ultrasonography indicated central nervous system abnormalities. Neurological examination showed no abnormality except for electroencephalographic spike activities. Magnetic resonance imaging revealed a cystic lesion in the left interhemispheric fissure, agenesis of the corpus callosum, and microgyria in the left frontotemporal lobes. Cerebral blood flow (CBF) was diffusely reduced. The cyst wall was partially removed and a cyst-peritoneal shunt procedure was performed. The histological diagnosis was glioependymal cyst. The spike activity disappeared and CBF dramatically improved after the operation.     

A case of free rupture of abdominal aortic aneurysm into the peritoneal cavity during posture change after induction of anesthesia

We report a case in which posture change for radiography after induction of anesthesia caused free rupture of the abdominal aortic aneurysm (AAA) into the peritoneal cavity, resulting in shock, although in the patient an AAA had ruptured into only the retroperitoneal space and hemodynamics had been stable preoperatively. The massive bleeding was controlled with autotransfusion using a washing salvaging autotransfusion device and a roller pump for hemodialysis. In addition, international mild hypothermia was effective for protection of the brain from suspected ischemia during shock. Meticulous attention should be paid for anesthetic management of patients with ruptured AAA even if their hemodynamic status is stable.     

Experimentally induced otitis media with effusion following inoculation with the outer cell wall of nontypable Haemophilus influenzae

Summary Previously, we extracted lipopolysaccaride endotoxin (LPS) from an axenic culture of Haemophilus influenzae and inoculated it into the middle ears of guinea pigs, inducing temporary serous effusions. In the present study, we tried to clarify whether the immunological mechanism responsible for producing the otitis media following outer cell wall inoculation was persistent. We extracted the outer cell wall from nontypable H. influenzae, using Zollinger's method, and inoculated extracts into the middle ears of guinea pigs that had previously received three injections of nonviable H. influenzae in Freund's complete adjuvant. Histological evaluations were performed from day 2 to day 24. Effusions and mucosal changes persisted for a longer time than in the LPS-inoculated model. Hypertrophied mucosae and increased numbers of goblet cells with hypersecretion were visible in the specimens on days 23–24. The condition seemed to show a greater similarity to chronic otitis media with effusion in children than did the LPS-inoculated model. We concluded that both the biological activity of the outer cell wall and immunological mechanisms might induce prolonged otitis media. We speculate that not only single middle ear infection but also general infections and repetitive middle ear infections may contribute to prolonged otitis media.     

Serum Bile Acid Levels in Preoperative and Postoperative Patients with Congenital Biliary Atresia

To elucidate the bile acid metabolism in the preoperative and postoperative stages of congenital biliary atresia (CBA), the unconjugated and conjugated bile acid levels in sera were measured by high performance liquid chromatography (HPLC). The results showed that the mean total serum bile acid (TSBA) level in the preoperative cases of CBA was higher, 122.1±39.0 n?mol/1 (1SD), and was about 12 times higher than the level in the age-matched normal controls (9.9±6.0). Even in the non-icteric patients several years after operation, the mean TSBA level was still much higher (15.2±9.6) than that of normal controls (5.7±3.1). The mean ratio of cholic acid to chenodeoxycholic acid (CA/CDCA) in the preoperative and postoperative cases of CBA was less than 1.0. The mean ratio of glycine-conjugated bile acids to taurine-conjugated bile acids (G/T) in the preoperative cases of CBA was the lowest (1.9±1.1). In the clinically good cases with sufficient bile flow after operation, G/T ratio was the highest (9.3±6.5). In the normal controls and the patients with preoperative and postoperative CBA, the main bile acids were glycocholic acid, taurocholic acid, glycochenodeoxycholic acid and taurochenodeoxycholic acid. These conjugated bile acids comprised more than 85% of the total in amount.     

Effect of hyperthermic vesical irrigation with bleomycin on the ultrastructure of the well-differentiated tumour and non-tumorous mucosa of the human urinary bladder

Summary Bladder tumours and non-tumorous bladder mucosa were studied by scanning and transmission electron microscopy in seven patients who had undergone hyperthermic vesical irrigation with bleomycin. The treatment induced sloughing of the outermost tumour cells, an increase of blebs and a decrease of cytoplasmic processes of the deeply located tumour cells as well as cellular degeneration. Although less severe, non-tumorous mucosa showed similar changes. Microvilli also appeared on the superficial cells of non-tumorous mucosa after the treatment. This treatment is effective by inducing cell degeneration and desquamation but not selective to the bladder tumour.