Autoregressive analysis of cardiac RR intervals in preterm and full-term infants

For the purpose of obtaining information on the maturation process of the autonomic nervous system in pre- and full-term infants, polygraphs were recorded during sleep from a total of 52 appropriate-for-dates infants at a conceptional age of 28–41 weeks. The 104 RR interval time series was calculated by auto-regressive (AR) and component analysis. Histograms of damping frequencies obtained were divided into two frequency bands: low frequency fluctuations (LF) of less the 0.1 cycle/beat (c/b) and high frequency fluctuations (HF) of more than 0.15 c/b. Total power and LF power decreased with increases in the conceptional age or postnatal age at a significance level of 0.01, respectively. In addition, the HF amount of bio-informing activity increased (P< 0.001) and the damping time of HF also increased (P <0.01). From these results, it was speculated that the activity of the sympathetic system decreases with increases in conceptional or postnatal age. It was also speculated that increased regularity and oscillatory duration in HF might be caused by the development of the reciprocal response of respiration to heart rate variation.     

The Role of the Biopsy in Diagnosis of Early Gastric Cancer

In order to determine the reliability of endoscopic biopsy indiagnosis of early gastric cancer, and to clarify the problemswith biopsies, preoperative endoscopic biopsies from 771 earlygastric cancer cases were reviewed and analyzed clinicopathologicallyin comparison with surgically resected specimens. The 771 cancerswere surgically resected at the National Cancer Center Hospitalduring the period from 1972 to 1982. Definite histological diagnosiswas obtained in 87.4% of the carcinomas at the initial biopsies.Repeated biopsy raised the percentage of correct definite diagnosesto 96.1%. False-negative (including suspicion of cancer) diagnosiswas most frequent in the case of depressed lesions (50 lesions).Half of the false negatives were found to be due to samplingerrors by the endoscopists. The other half of these 50 lesionswere diagnosed as "suspicious of malignancy" because of thehistological difficulty in differentiating early gastric cancerfrom regenerative atypia with intestinal metaplasia, or becausethere was not enough information, or for the other reasons.Most of the 31 false-negative diagnoses at the initial biopsyfrom elevated lesions were reported as adenoma (group III) orsuspicious of carcinoma (group IV), indicating that differentialdiagnosis between well-differentiated adenocarcinoma and adenomais very difficult. The result of the present study suggeststhat repeated biopsy from correct sites and discussion of thelesions between clinicians and pathologists are very important. ^**Present affiliation: Toranomon Hospital, Toranomon 2-2-2,Minato-ku, Tokyo 105, Japan.     

Metastatic Tumors of the Stomach Detected by Endoscopy

Thirteen patients with gastric metastasis were examined endoscopicallyand their diseases were diagnosed histologically at the NationalCancer Center Hospital from 1962 to 1980. Their endoscopic findings were analyzed. The metastatic lesionwas solitary in 10 of the 13 cases and multiple (9 lesions)in three. Although 12 of the 13 cases showed elevated lesionsendoscopically, ulcerated hemispherical nodules, which correspondto the "bull's-eye sign" of Pomerantz roentgeno-graphically,were observed in only four cases. In the remaining nine casesthe endoscopic findings were submucosal tumor without centraldepression (2 cases), a cancer-like appearance (6 cases) orextragastric compression (1 case). The majority of these metastatic lesions (9 of the 19; 47.3%)were located along the greater curvature of the stomach. Fromthese results, the elevated lesion of the greater curvaturemight suggest a metastatic tumor regardless of the conventionalcriteria (multiplicity or ulcerated hemispherical nodule) whenthe patient has cancer in other organs.     

Nonulcerative Lesion Detected by Endoscopy as an Early Expression of Gastric Malignancy: --Retrospective Observation of 72 Cases of Gastric Carcinoma--

To evaluate the endoscopic criteria for early malignant findingsof gastric carcinoma more precisely, a retrospective examinationof endoscopic pictures of 72 patients with gastric carcinomawas carried out. The patients had received endoscopic examinationsrepeatedly for years and proceeded finally to surgery on thebasis of a diagnosis of carcinoma by gastric biopsy. The macroscopicas well as microscopic findings of the resected specimens werecompared with the previous endoscopic observations. Ulcerative lesions were predominantly found at the initial endoscopyin patients whose final diagnosis was the lie type of earlygastric cancer or IIc-like advanced cancer. These patients usuallyreceived endoscopic examinations repeatedly and their lesionswere diagnosed as malignant by the adopted criteria of earlygastric cancer 2 to 6 yr after the initial examination. In contrast, nonulcerative lesions were observed more frequentlyat the initial examination in patients with the final diagnosisof the IIa+IIc type of early gastric cancer or Borrmann typeof advanced cancer. In most of those patients endoscopic examinationwas not carried out so frequently, and in some of those whohad been closely followed the malignant findings appeared rathersuddenly with tumorous formation as well as deeper invasionduring less than a few years from the previous examination atwhich the tumor had been considered benign. These data indicate that the nonulcerative lesions which wereconsidered benign could be the early expression of gastric carcinoma.It should be stressed that nonulcerative lesions such as "irregularerythematous change, discoloration, flat granular change" and"simple mucosal depression" observed in some parts of the stomachwould be important site for the detection of early gastric carcinoma,and that these lesions need to be biopsied more frequently.     

Developmental changes in electroencephalogram for term and preterm infants using an autoregressive model

The purpose of the present study was to clarify the developmental changes of electroencephalogram (EEG) background activity in term and preterm infants that take place with increasing conceptional age (CA) through an autoregressive (AR) model. Polygraphical EEG recordings were obtained from 76 healthy term and preterm infants with a CA ranging between 31 and 40 weeks. Decreases in total power and component power of δ were noted with CA during burst activity (BA) in quiet sleep (QS) and during active sleep (AS). Increases in total power and component power of δ were noted with CA during interburst interval activity (IBIA) of QS. Regression analysis (RA) of the information amount (IA) indicated a negative correlation with increasing CA in AS and in the monopolar EEG tracings Fp1, C3, O1 and O2 in BA, and a positive correlation in O1 in IBIA. Regression analysis of the IA of δ indicated a negative correlation with increasing CA in AS and in Fp1, C3, O1 and O2 in BA, and a positive correlation in O1 in IBIA. Regression analysis of the IA of δ indicated a negative correlation with increasing CA in BA and AS. These results showed that the high voltage slow wave component changed to a low voltage slow one with development in AS and that BA was longer in duration and lower in power with increasing CA, while IBIA was shorter in duration and higher in power. In conclusion, significant developmental changes occur in all derivatives of AS. Even though the EEG of BA and IBIA change separately, they are followed by EEG of QS in a continuous pattern.     

Malignant Mesenchymoma of the Liver with Hypercalcemia Report of a Case

A case of malignant mesenchymoma of the liver is reported. Thediagnosis was confirmed on the surgical specimen. The patientshowed marked hypercalcemia. Parathyroid hormone assay was negative.     

Adenosquamous Cell Carcinoma of the Colon with Severe Hypercalcemia: --Report of Two Cases--

Two patients with adenosquamous cell carcinoma of the colon,who presented severe hypercalcemia, are reported. Adenosquamouscell carcinoma of the colon is relatively rare, and there wereonly two cases among 1,053 patients who were hospitalized withmalignancy in the large intestine at the National Cancer CenterHospital during the past 18 years. Both of these cases presentedlethal hypercalcemia in the absence of osseous metastasis, andthere were no other patients who had malignant tumors of thelarge intestine and presented hypercalcemia. These observationssuggest that there is a close relationship between the squamouscell component and the occurrence of hypercalcemia, as is observedin the case of lung cancer. Radioimmunoactive parathyroid hormonewas undetectable in the plasma and the tumor tissue in thesetwo cases.     

Two Cases of Carcinoid Tumor of the Stomach which Responded to Oral Coadministration of Tegafur and Uracil

Tegafur, 1-(2-tetrahydrofuryl)-5-fluorouracil, was administeredin combination with uracil to two patients with carcinoid tumorof the stomach and the effect of the drug was evaluated. The first patient was a 67-yr-old woman. She was admitted becauseof an upper abdominal tumor. Exploratory laparotomy revealeda gastric tumor and an additional huge tumor with liver metastasisand peritoneal dissemination. Histological examination of biopsyspecimens from the gastric tumor and metastatic lesions revealedcarcinoid tumor. Tegafur and uracil were coad-ministered postoperatively.During three months of treatment the gastric tumor improvedendoscopically and the large abdominal tumor decreased from10x10 cm to 4x4 cm. The second patient was a 55-yr-old man. He was admitted becauseof severe diarrhea. Biopsy from a gastric lesion and metastaticskin lesions revealed carcinoid tumor. After coadministrationof tegafur and uracil and mitomycin C, the metastatic skin lesionsbecame smaller and some of the lesions disappeared. The liveralso decreased in size. These two cases suggest the possibility that coadministrationof tegafur and uracil may be effective for carcinoid tumor ofthe stomach.     

Colo-Rectal Carcinoma in Young Adults

A study of 25 young adults under the age of 29 treated by surgeryfor carcinoma of the large intestine was made to compare with693 older-age group of patients. The incidence of adenocarcinomaof the large intestine in the first thirty years of life was3.5%. At the time of surgery, 64% of the patients had metastaticdisease, and the five-year survival rate for 19 curatively treatedcases was 37%. The coincidental second and third carcinoma ofthe large intestine and the association of familial polyposiscoli were significantly frequent in the younger age group. Onthe other hand, the association of ulcerative colitis or Crohn'sdisease could not be found in either of the group. The highincidence of mucin-producing tumors in the younger group wasalso confirmed. The Cumulative No Evidence of Disease (NED)rate after the curative surgery was lowest among patients ofthe first-three-decade age group and showed; stepwise high valueas the decade of age increased.     

Multivariate autoregressive analysis of carotid artery blood flow waveform in an infant of a diabetic mother with cardiomyopathy

We analyzed the carotid artery blood flow waveform (CABFW) of an infant of a non-insulin dependent diabetic mother with hypertrophic cardiomyopathy (IDM cardiomyopathy) through multivariate autoregressive analysis and compared the developmental change of his CABFW with that of normal newborns. The total power was lower than normal newborns on the second and third day of life when his heart dysfunction was severe, and elevated on the fifth day of life when normal-heart function was recovered. The power of component 3 (C3), of which the damping frequency was 7–11 Hz, was slightly high on the second and third day of life and it decreased to the normal range on the fifth day of life by component analysis. In contrast, the power of C3 increased with decreasing resistance index of anterior cerebral artery (RI of ACA) which shows the cerebral vascular resistance of normal newborns. These results suggest that the carotid artery blood flow volume decreased by low cardiac output and the cerebral vascular resistance decreased to maintain the cerebral circulation, when the heart dysfunction was severe.