A Small Gastric Cancer in Association with Menetrier Disease

Abstract: We studied a 57-year-old man who was diagnosed as having giant rugae at a mass-screening for gastric cancer. He was examined endoscopically for check-up purposes. In addition to giant rugal folds which occurred throughout the entire fundus and body of the stomach, a type IIc lesion was noted in the posterior lower wall of the gastric body. A biopsy revealed signet ring cell carcinoma. A total gastrectomy was performed. A resected specimen was serially sectioned and underwent histopathological examination; hypertrophy and cystic elongation of the gastric glands indicative of so-called giant hypertrophic gastritis was seen. The histological type of the type IIc lesion was undifferentiated adenocarcinoma with the signet ring cells being confined to the mucosal layer. This patient had a rare case of Menetrier's disease complicated by intramucosal carcinoma.     

The Specificity of the Penetrating and the Superficial Spreading Types of Early Gastric Cancer—Classification of Early Gastric Cancer Using the Interactive Image Analysis System—

Abstract: Specific types of early gastric cancer were investigated in accordance with the cancer surface area and the degree of penetration by means of quantitative measurements of the surface area of early gastric cancer using the interactive image analysis system. The results indicated a significant correlation between the surface area and the penetration depth in ordinary early gastric cancer. However these correlations were not observed in both well and poorly differentiated adenocarcinoma cases of the so-called PEN and SUPER types, which showed a significant specificity when compared with ordinary early gastric cancer. The PEN and SUPER types of early gastric cancer also exhibited various clinicopathological characteristics, and it was suggested that the poorly differentiated PEN type might be the initial lesion of a linitis plastica type gastric cancer. Examination of the conditions of the mucosa surrounding the cancer revealed a difference between the PEN and the SUPER types, and this suggested that the environment at the site of a cancer growth influences the type of growth and the spread of early gastric cancer.     

Successful Radiofrequency Current Catheter Ablation of Sustained Ventricular Tachycardia

We performed radiofrequency current catheter ablation in two patients with nonischemic sustained ventricular tachycardia (VT). In one patient, two morphologically distinct VTs were induced by electrical stimulation. One showed right bundle branch block pattern and the other left bundle branch block pattern. The earliest site of activation during each VT was determined at the septum of the right ventricle. However, these two sites were close to the His-bundle elecfrogram recording area. In the other patient, a VT with a left bundle branch block pattern occurred spontaneously after the administration of isoproterenol. The earliest site of activation during VT was determined at the outflow tract of the right ventricle. During tachycardia, radiofrequency current ablation (40 W ± 30 sec) was delivered to the earliest site of activation, A few seconds after fulguration, each VT was terminated and additional radio-frequency currents were given near these sites. After the ablation, VT could not be induced by the electrical stimulations, nor did it recur. No side effects were observed and the atrioventricular conduction remained intact. We feel that nonischemic VTs could possibly be treated by using radiofrequency current catheter ablation.     

LASER THERAPY FOR GLAUCOMA

Three laser techniques for the treatment of glaucoma are described. The short-burn technique of argon laser iridotomy permitted perforation of the peripheral iris in one session without serious complications, thereby alleviating pupillary block in angle-closure glaucoma. The rates of successful intraocular pressure (IOP) control and visual acuity loss due to cataract progression were similar in laser iridotomy and surgical iridectomy. The tonographic outflow facility remained unchanged after argon laser iridotomy.
Techniques of argon laser trabeculoplasty (AL TJ to the anterior and posterior aspects of the trabecular band were evaluated. The anterior ALT gave fewer complications, but a lower IOP control rate than the posterior ALT. Posterior ALT over 180° with about 50 burns gave fewer complications than treatment over 360° with about 100 burns, yet the final effects in IOP control were better after the 180° than after the 360° treatment.
Nd-YAG laser irradiation can separate dysgenetic iris insertion from the trabecular band in developmental glaucoma without serious complications. This Nd-YAG laser goniotomy may be useful for the treatment of juvenile primary developmental glaucoma.     

A comparison of the dissolution rates of caffeine tablets in a rotating-basket with those in a Sartorius dissolution tester

Uncoated caffeine tablets of four different hardnesses were tested for dissolution rate by the Sartorius (S.S. method) and by the rotating basket method of the U.S.P. XVIII. In both methods the dissolution rate decreased with increasing hardness, and the rate obtained with the S.S. method was always less than that by the U.S.P. method. This result cannot be explained as being due only to the difference in the volume of dissolution medium. Also it was difficult to ensure that the characteristic changes in the process of dissolution paralleled the curves obtained from a plot of % caffeine dissolved vs time. Accordingly, the dissolution rate constants were calculated from the slope of each straight line in a plot of In W^∞/(W^∞ - W) vs time.     

Two Cases of Ventricular Parasystole Associated with Ventricular Tachycardia

In two patients, ventricular pamsystole (VP) was associated with ventricular tachycardia (VT), and in one patient, catheter ablation was successful. In patient 1, with dilated cardiomyopathy, VP led to VT, which converted to ventricular fibrillation. In patient 2, VP led to symptomatic nonsustained polymorphic VT. The origin of parasystolic focus was determined byendocardial mapping, and a radiofrequency current was delivered to patient 2. Both VP and VT disappeared immediately, and no recurrence has been observed during a follow-up of 8 months. Catheter ablation to the parasystolic focus was effective and a relationship between VP and VT was strongly suggested.     

Development of a Submucosal Tumor-like Protrusion at the Site of a Gastric Ulcer during H2-Blocker Treatment—Report of a Case—

Abstract: We studied a patient with a gastric ulcer in which the entire ulcer protruded like a submucosal tumor. Candida albicans was observed in the biopsy specimen taken during treatment with cimetidine; the tumor disappeared after treatment with an antifungal agent, both topically and orally. The patient was a 68-year-old male who had undergone periodical endoscopic examinations of his upper digestive tract although he did not complain of any subjective symptoms. He was admitted to Suma Red Cross Hospital because examination revealed an active ulcer on the greater curvature of the fornix of the stomach. The patient was treated with 800mg/day of cimetidine. After ten days of treatment, endoscopic studies revealed the elevation of the entire ulcer, which grew into a mass resembling a submucosal tumor associated with a bridging fold. A biopsy of the periphery of the ulcer revealed the presence of Candida albicans in the tissue specimen. Endoscopic ultrasonography revealed a tear in the submucosa and an inflammatory picture that extended into the tunica muscularis. The patient was diagnosed as having a Candida-infected gastric ulcer. Concomitant use of topical and oral fungizon resulted in the protuberance settling; it was confirmed that the tumor mass completely disappeared and the ulcer healed after 58 days of treatment.     

Hypertensive crisis after discontinuation of an angiotensin-converting enzyme inhibitor in a patient with renal dysfunction

SUMMARY: A 54-year-old woman with hypertension treated for 2 years with enalapril, 10 mg daily, was admitted to hospital because of progressively worsening renal function. There was no evidence of scleroderma, except for the presence of anticentromere antibodies. to prevent hyperkalaemia and further deterioration of renal function, enalapril was abruptly withdrawn and replaced with a calcium antagonist on the second hospital day, but hypertensive crisis developed. Renal failure requiring haemodialysis developed 2 weeks after admission. Findings of a renal biopsy were consistent with scleroderma kidney. Scleroderma is difficult to diagnose in the absence of cutaneous symptoms. Therefore, angiotensin-converting enzyme inhibitors should only be discontinued with care in patients with renal dysfunction if there is the possibility of scleroderma without skin changes.     

Mucosal Tag of the Duodenum: —Report of a Case—

Abstract: We studied a 66-year-old female who had a dull epigastric pain. An upper gastrointestinal (GI) series revealed a cordlike protrusion in the duodenal region, and a gastroendoscopic examination was performed and revealed a mucosal tag (MT) about 3 cm in length in the duodenal bulb. The MT was resected endoscopically and was found to be lined by normal duodenal mucosa and to have developed hyperplasia of the Brunner's glands. This MT was considered to be a congenitally-developed, hamartomatous hyperplasia of the duodenal mucosa, and of the Brunner's glands in particular.