Obstinate cough as a sole presenting symptom of non-metastatic renal cell carcinoma

Renal cell carcinoma (RCC) causes many kinds of symptoms such as hypercalcemia, hypertension, polycythemia and fever. Here we describe a rare case of RCC presenting with a persistent cough. After radical nephrectomy, the obstinate cough disappeared. When the tumor recurred locally, the cough also recurred. Furthermore, the cough disappeared completely again after the removal of the recurrent tumor. Although all the clinical findings suggested that the RCC caused the cough, we could not identify a specific humoral substance responsible for the cough.     

Cosmetic benefits of lower midline skin incision for pediatric open heart operation

OBJECTIVE: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach. METHODS AND RESULTS: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt. CONCLUSION: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.     

Study on the mass-screening of after-meal serum triglyceride concentration]

The serum triglyceride concentration (TG) tested in health checks after meals cannot properly sort out hypertriglyceridemia with reference to the upper normal limit of fasting TG (150 mg/dl) set by the Japan Arteriosclerosis Society, because TG goes up considerably after a meal. In our survey of a large number of health check examinees (free of abnormal biochemical data other than TG and diseases under medical treatment), the mean (M) of fasting TG + 2 standard deviations (SD) was close to 150 mg/dl. When the screening level was set at M + 2SD for each time span after a meal, the ratio of the screened was distributed between 19.9 and 21.8%, which was close to 23.5%, the ratio of the screened on fasting. Accordingly, the nearest round number ending with zero for the first digit is suggested to be of practical use for the screening level of after-meal TG. The average TG in females was definitely lower than that of males, though proportionately increasing with age. The ratio of the screened among females aged between 20 and 49 was 5.3% on fasting and 3.2-5.8% for after-meal time spans, and that of the screened aged in their fifties was 11.3% and 8.2-12.9% respectively.     

Local blood flow changes in malignant brain tumours under induced hypertension

Summary Changes in tumour blood flow under an induced hypertensive state were examined in malignant brain tumours to know if the precondition for the effectiveness of induced hypertensive chemotherapy — relative increase in tumour blood flow — are fulfilled. Tumour blood flow was measured under both a resting and an induced hypertensive state in 12 patients with various malignant brain tumours (6 gliomas, 6 metastatic brain tumours) using xenon-enhanced computed tomography. The blood pressure was elevated 40% above the systemic blood pressure of the resting state by the infusion of angiotensin II. Tumour blood flow increased 30% on average above the normal brain tissue blood flow after the induction of an induced hypertensive state (p < 0.05). The tumour blood flow increased in 11 cases of malignant tumours, but decreased in one case with massive brain oedema after induced hypertension. The increase in blood flow was higher in hypervascular tumours and less in hypovascular tumours. Therefore, induced hypertensive chemotherapy probably will be more effective in hypervascular malignant brain tumours with small mass effects.     

A case of parkinsonism induced by an oral contraceptive]

We report a case of parkinsonism induced by long term administration of an oral contraceptive. A 38-year-old woman complained of easily stumbling, démarche à petit pas and fatiguability in her lower extremities since January, 1991. When examined on April 5, 1991, she explained taking an oral contraceptive for 7 years on her doctor's recommendation after two times artificial abortions. Her facial expression was mask-like and body was bent forward with knee joints flexed and arms flexed at elbow joints. She had frozen gait with inactive pendulousness of the arms. We could find her muscle rigidity in both upper and lower extremities, especially in her right side extremities. A brain MRI finding was lacunar infarction which proton density weighted and T2-weighted MR images showed small patches of high-signal intensities in white matter of the bilateral frontal lobes and in left periventricular white matter. Her symptoms improved after stopping administration of the oral contraceptive and starting combination therapy with nicergoline and bromocriptine. She had some leg fatiguability at the onset of her next menstruation in May, but it was much less than her previous condition. When her menstruation terminated, those symptoms disappeared and it was possible to stop the administration of bromocriptine and nicergoline, and her symptoms have improved.     

A possible involvement of central atrial natriuretic peptide in cerebral cortical microcirculation.

The possible involvement of atrial natriuretic peptide (ANP) in cerebral cortical microcirculation was investigated in rats by means of laser-Doppler flowmetry and immunohistochemistry. In the laser-Doppler study, local cerebral blood flow (LCBF) changes after the administration of 10(-6) to 10(-8) mol/LANP solution or vehicle (saline solution) as an intracortical injection for 5 minutes were continuously monitored throughout the 30 minutes of the study and were expressed as percentages of preinjection values represented as 0%. The administration of 10(-6) to 10(-8) mol/LANP caused a significant decrease in LCBF; the onset of LCBF responses occurred within a few minutes after the start of the injection and the decrease in LCBF reached the maximum level within 7 to 10 minutes after the completion of the administration, after which LCBF gradually recovered. In the immunohistochemical study, no specific ANP immunoreactivity was found associated with the intraparenchymal blood vessels; however, ANP-immunoreactive neurons were observed primarily in the hypothalamus and septum, in which high concentrations of ANP-containing neurons have been identified. The data from the laser-Doppler study suggest that central ANP may produce a vasoconstriction of the intraparenchymal blood vessels, regardless of whether through direct action on these vessels or through the mediation by some system in the central nervous system. Because there is no evidence for ANP-containing nerves around these vessels, the role of central ANP in the cerebral circulation must await identification of the source of perivascular ANP.     

Transplantation of cultured sympathetic ganglionic neurons into Parkinsonian rat brain: Survival and function of graft

Summary The superior cervical ganglia (SCG) of newborn rats, which had been cultured as expiants for varying periods of time, were transplanted into the striatum of rats with unilateral 6-hydroxydopamine lesions of the nigrostriatal dopamine pathway to examine the survival and functional properties of the sympathetic neurons maintained in long-term culture prior to grafting. In the rats given the SCG cultured in vitro for 2 weeks, apomorphine-induced rotational behaviour was satisfactory reduced. The rats receiving the SCG from 4-week-old cultures showed only modest behavioural changes. The grafting of the SCG cultured for 6 weeks in vitro did not affect the rotational behaviour. These behavioural data corresponded with the histological assessment of the graft survival by use of catecholamine histofluorescence. The present results suggest the critical time period in vitro which might allow the cultured sympathetic neurons to be successfully grafted.     

Case Study: Gerstmann's syndrome associated with chronic subdural haematoma: a case report

We report a patient who exhibited Gerstmann s syndrome in association with a chronic subdural haematoma. A 71 year old right handed woman presented with mild right arm and leg weakness that began 2 weeks prior to admission. Neurological examination on admission revealed a mild right hemiparesis. Neuropsychological examination revealed right-left disorientation, finger agnosia, agraphia, and acalculia, but no language disturbance. A computerized tomographic CT scan revealed a large left frontoparietal, extra axial hypodense fluid collection containing scattered hypodense foci. A left parietal evacuation of the haematoma was performed. Following surgery the patient dramatically improved. We suggest that the direct compression by the chronic subdural haematoma or a hemispheric pressure difference caused Gerstmann s syndrome. This is an unusual report of a Gerstmanns syndrome following chronic subdural haematoma.