A case of thyroid cancer causing right ventricular outflow tract obstruction is described. A 72-year-old woman was admitted because of shortness of breath, some ecchymoses, and marked anasarca. Her liver was palpable four fingerbreadths below her costal margin. Laboratory findings included leukocytosis, marked thrombocytopenia, and an increase in fibrinogen degradation products due to disseminated intravascular coagulopathy. Two-dimensional echocardiography demonstrated a solid mass in the right ventricle, which protruded into the right atrium and main pulmonary artery. Right ventricular outflow tract obstruction and tricuspid regurgitation were demonstrated by contrast echocardiography. These findings were confirmed by CT scans, RI angiography, and contrast angiography. The mass was partially resected from her right ventricle and her tricuspid valve was replaced successfully, but she died of sepsis three weeks after surgery. At autopsy, undifferentiated thyroid cancer and cardiac metastasis were verified. To date, only eight cases with initial symptoms of congestive heart failure due to right ventricular outflow tract obstruction caused by metastatic intracavitary tumors have been reported. Very rarely have cardiac tumors resulted in disseminated intravascular coagulopathy.

Aged↗

PubMed1986

[A study on the cause of urolithiasis of the upper urinary tract--clinical study of risk factors in the formation of stones in the upper urinary tract].

Various risk factors and inhibitors of the stone formation of the upper urinary tract have been pointed out in urine. We examined the amount of daily excretion of several important risk factors (calcium, phosphorus, urate and oxalate) and inhibitors (magnesium and citrate) in the urine of 21 healthy males, 13 male single stone formeks and recurrent and/or multiple stone formers before and after taking the regular diet which contains 500 mg of calcium and 1,000 mg of phosphorus a day. The daily excretion of calcium, phosphorus and magnesium indicated no significant differences among the 3 groups. The excretion of oxalate in urine for 24 hours was significantly decreased in the stone formers after taking the regular diet. The urinary excretion of the urate per body surface area in the stone formers was significantly higher than that in the healthy control. The amount of the excretion of the citrate in urine in the recurrent and/or multiple stone formers was significantly lower than that in the other 2 groups. Many patients of the recurrent and/or multiple urinary stones had more than two abnormal values of above-mentioned risk factors and inhibitors. These results suggest that the causes of the formation of the upper urinary stone were not single but multiple and that the dietary advice to these patients was important against the recurrence of the urolithiasis.

Adult↗

PubMed1986

Studies on the evaluation of joint functional impairment in the lower extremities--examination by multivariate analysis.

Multivariate analysis was applied to develop systems which afford more objective and universal evaluation of joint function in the lower extremities such as the hip, knee, and ankle joint. Conventional methods have various drawbacks, such as selection of parameters, allocation of points to selected parameters, selection of indices to represent impairment of joint function as a whole, and functional evaluation in polyarticular impairment. In order to solve these problems, causative factors (pain, mobility, and stability) of the joint impairment and secondary factors such as activities of daily living (ADL) representing the overall effects of the causative factors were strictly discriminated, and only causative factors were selected to serve as functional parameters. Then, taking ADL as criterion variables and causative factors as predictor variables, multiple regression analysis was performed using 207 hips, 250 knees, and 50 ankle joints. Based on this analysis, an original system for evaluating joint function was developed.

Activities of Daily Living↗

PubMed1986

[Experience with microsurgical epididymovasostomy (specific tubule technic: end-to-end anastomosis by the Silber method)].

Here, we report 2 cases of epididymovasostomy operation in which good results were obtained. These operations were done for patients whose complaints were male sterility due to obstructive azospermia after bilateral epididymitis. The method of this operation was reported by Silber in 1978 as "specific tubule technique", and excellent results have been reported. Herein, we introduce this technique perhaps for the first time in Japan, and the characteristics of this method are considered. The important factors and characteristics of this method are that it is very reasonable with a high success rate, it is more difficult than microsurgical vasovasostomy, it is a time-consuming operation. Epididymovasography should not be done preoperatively but intraoperatively, if possible and chronic epididymitis should be ruled out by serological study and culture study.

Adult↗

PubMed1986

[Mitral regurgitation due to ruptured chordae tendineae: sensitivity and specificity of the diagnostic criteria by two-dimensional echocardiography].

The sensitivity and specificity of the two-dimensional (2D) echocardiographic criteria for diagnosing ruptured mitral chordae tendineae (RCT) were assessed in 52 cases with non-rheumatic mitral regurgitation undergoing mitral valve prostheses. At surgery, chordal rupture was confirmed in 38 cases (RCT group), but not in 14 cases (non-RCT group). Four presumptive and three definite findings for diagnosing mitral chordal rupture using 2D echo were evaluated. Mitral valve prolapse with incomplete coaptation of the mitral leaflets in the long-axis view was observed in 32 cases in the RCT group and in four cases in the non-RCT group (sensitivity 84%, specificity 80%). In the short-axis view at the level of the mitral orifice, delayed closure of the involved mitral leaflet was observed in four cases in the RCT group but in none of the non-RCT group (sensitivity 11%, specificity 100%), delayed protodiastolic opening of the involved leaflet in 15 cases of the RCT group and in one of the non-RCT group (sensitivity 39%, specificity 92%), and finally, increased excursion of the involved valve in 27 cases of the RCT group and in three cases of the non-RCT group (sensitivity 71%, specificity 79%). The following three echocardiographic findings were regarded as direct evidence of mitral chordal rupture: Fine echoes with abnormally rapid transverse and/or oblique motion around the mitral orifice in the short-axis view were observed in 13 cases of the RCT group (sensitivity 34%, specificity 100%); echoes with abnormal whip-like motion in the long-axis view in 10 cases (sensitivity 26%, specificity 100%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

[Experimental and clinical studies on calcium lithiasis. II. Prevention of recurrent calcium stones with thiazides and allopurinol].

We evaluated 113 patients with recurrent or multiple calcium urolithiasis at our outpatient stone clinic between 1980 and 1983. Diagnostic categories included hypercalciuria (36 patients), hyperoxaluria (35 patients), and hyperuricosuria (31 patients). Thiazides and/or allopurinol were administered to the hypercalciurics and hyperuricosurics, respectively for prevention of stone recurrence. Patients followed up for more than one year were 23 (male 16, female 7) in the thiazide group, and 15 (male 12, female 3) in the allopurinol group. The mean treatment interval was 2.49 years in the former, and 2.35 years in the latter. The remission rate (percentage of patients without formation of any new stones) was 82.6% in the thiazide group, and 73.3% in the allopurinol group. The group stone formation rate was reduced from 0.85 to 0.35/pt-yr in the thiazide group, and from 0.74 to 0.27/pt-yr in the allopurinol group. Efficacy of these two drugs for the prevention of calcium stone recurrence was observed in this selective therapy, but a careful double blind study should be carried out to draw a definite conclusion.

Allopurinol↗

PubMed1986

[Clinical statistics in the Outpatients Clinic of the Department of Urology, Kyoto University Hospital 1983 and 1984].

Explore the source record for details and available documents.

Adolescent↗

PubMed1986

[Clinical statistics of the admitted patients at the Department of Urology, Kyoto University Hospital 1983-1984].

Explore the source record for details and available documents.

Adolescent↗

PubMed1986

[Results of the multidisciplinary treatment of invasive bladder cancer].

Of the 843 patients with bladder cancer treated at Kyoto University between 1965 and 1984, 156 patients (18.6%) received total cystectomy. Between 1980 and 1984, 60 patients underwent multidisciplinary treatment with 4,000 or 2,400 rad adjuvant preoperative radiation therapy to the whole pelvis followed by radical cystectomy with or without postoperative adjuvant chemotherapy. The 5-year survival rate for the 65 patients with pelvic lymphadenectomy was 66% and that for the 40 patients without lymphadenectomy or only biopsy was 35%. The 5-year survival rate after radical cystectomy for 20 bladder cancer patients with regional lymph node metastasis was 11% and 73% for 59 patients without lymph node metastasis (p less than 0.001). The survival rate of multidisciplinary treatment protocol for muscle invasive bladder cancer was 55% a significantly (p less than 0.05) improved survival compared to the historical control. For analysis, the patients were divided into 2 categories according to histological criteria for evaluation of therapeutic effects for preoperative radiation by Ohoshi and Shimosato. The two groups were non-responder: grade I and IIa changes and responder: grade IIb, III and IV. Survival for responders and non-responders revealed significant differences (p less than 0.05), 87% for 28 responders and 48% for 24 non-responders.

Adult↗

PubMed1985

Effects of catecholamines, monophenolamines and phenylamines on identifiable giant neurons of an African giant snail (Achatina fulica Férussac).

The effects of catecholamines, monophenolamines and phenylamines on eight identifiable giant neurons of an African giant snail (Achatina fulica Férussac) were examined to classify these neurons into several categories according to their sensitivities to the various substances. The five neurons, PON (periodically oscillating neuron), TAN (tonically autoactive neuron), 1-VMN (left-visceral multiple spike neuron), d-RPeAN (dorsal-right pedal autoactive neuron) and VIN (visceral intermittent firing neuron), were sensitive to catecholamines. Of these neurons, PON was excited most markedly by dopamine (dopamine-sensitive); TAN, 1-VMN and d-RPeAN were inhibited most markedly by epinine (epinine-sensitive); and VIN was excited equally by the four catecholamines, dopamine, epinine, L-noradrenaline and L-adrenaline (widely sensitive). The three other neurons, FAN (frequently autoactive neuron), d-LPeLN (dorsal-left pedal large neuron) and d-LCDN (dorsal-left cerebral distinct neuron) were sensitive to monophenolamines. DL-Octopamine was the most inhibitory on FAN and d-LCDN, but was the most excitatory on d-LPeLN. DL-Synephrine had the same but somewhat weaker effects on the three neurons as did DL-octopamine. The three phenylamines, L-phenylalanine, beta-phenylethylamine and DL-beta-phenylethanolamine, had no effect on any of the eight neurons examined.

2-Hydroxyphenethylamine↗

PubMed1985

Serum lactate dehydrogenase isoenzyme-1 in children with yolk sac tumor.

Although in recent years the evidence of an increase in serum lactate dehydrogenase isoenzyme-1 (LDH-1) in patients with germ cell tumor (GCT) has attracted attention, there have only been a few reports concerning yolk sac tumor (YST), which is a frequent type of GCT in childhood. Serum LDH isoenzymes were determined in eight children with YST, and an increase in LDH-1 was found in seven of them, excluding one in an early stage. On the basis of the findings of serial serum LDH-1 levels during treatment and of LDH isoenzyme pattern in tumor tissues, it is presumed that the increased serum LDH-1 is derived from tumor tissues. LDH-1 seems to be useful as a tumor marker, not specific for YST but associated with the whole spectrum of GCT, for monitoring of YST.

Child, Preschool↗

PubMed1985

Effects of four stereoisomers of beta-hydroxyglutamic acid on identifiable giant neurons of an African giant snail (Achatina fulica Férussac).

The effects of four stereoisomers of beta-hydroxyglutamic acid (erythro-L-BHGA, threo-L-BHGA, erythro-D-BHGA and threo-D-BHGA) and glutamic acid (L-Glu and D-Glu) were compared on six identifiable giant neurons of Achatina fulica Férussac, namely, PON (periodically oscillating neuron), VIN (visceral intermittently firing neuron), d-RPLN (dorsal-right parietal large neuron), RAPN (right anterior pallial neuron), FAN (frequently autoactive neuron) and v-RCDN (ventral-right cerebral distinct neuron). On PON and VIN, erythro-L-BHGA was the most inhibitory (effective potency quotient (EPQ) of the substance: 1.0). Its minimum effective concentration (MEC) for both neurons was the same at 3 X 10(-5) M. The effect of threo-L-BHGA was weaker (EPQ in relation to the most effective substance: 0.3-0.1). Erythro- and threo-D-BHGAs were almost ineffective on PON (EPQ: less than 0.03) though they had some effects on VIN (EPQ: 0.1-0.03 for erythro-D-BHGA and 0.3-0.1 for threo-D-BHGA). On d-RPLN, erythro-L-BHGA was the most excitatory (MEC: 10(-4)M). Threo-L-BHGA and threo-D-BHGA also had some effects (EPQ: 0.1 and 0.3 respectively), while erythro-D-BHGA was ineffective. On RAPN, erythro- and threo-L-BHGAs were the most excitatory (MEC: 10(-4) M). Threo-D-BHGA was also excitatory (EPQ: 0.3), while erythro-D-BHGA was ineffective. Threo-L-BHGA was the most inhibitory on FAN and v-RCDN (MEC: 10(-4) M in FAN and 10(-5) M in v-RCDN).(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗

PubMed1985

Tongue-muscle-controlling motoneurons in the Japanese toad: topography, morphology and neuronal pathways from the 'snapping-evoking area' in the optic tectum.

As a step to clarifying the neural bases for the visually-guided prey-catching behavior in the toad, special attention was paid to the flipping movement of the tongue. Tongue-muscle-controlling motoneurons were identified antidromically, and their topographical distribution within the hypoglossal nucleus, the morphology, and the neuronal pathways from the optic tectum including the 'snapping-evoking area' (see below) to these motoneurons were investigated in paralyzed Japanese toads using intracellular recording techniques. The morphology of motoneurons innervating the tongue-protracting or retracting muscles (PMNs or RMNs respectively) was examined by means of intracellular-staining (using HRP/cobaltic lysine) and retrograde-labeling (using cobaltic lysine) methods. Both PMNs and RMNs showed an extensive spread of the branching trees of dendrites; 4 dendritic fields were distinguished: lateral/ventrolateral, dorsal/dorsolateral, medial, and in some motoneurons, contralateral dendritic fields, although there was a tendency for the dorsal/dorsolateral dendritic field to be less extensive in the PMNs than in the RMNs. The axons of both PMNs and RMNs arose from thick dendrites, ran in a ventral direction without any axon-collaterals branching off, and then entered the hypoglossal nerve. The PMNs and RMNs were distributed topographically within the hypoglossal nucleus; the RMNs were located rostrally within the nucleus, whereas the PMNs were located more caudally within it. In about 3/4 of the RMNs tested, depolarizing potentials [presumably the excitatory postsynaptic potentials (EPSPs)], on which action potentials were often superimposed, were evoked by electrical stimuli applied to the nerve branch innervating the tongue protractor. These EPSPs were temporally facilitated when the electrical stimuli were applied at short intervals (10 ms). Both PMNs and RMNs showed hyperpolarizing potentials (IPSPs) in response to single electrical stimuli of various intensities (10-200 microA) applied to the 'snapping-evoking area' (lateral/ventrolateral part of the optic tectum) on either side. These IPSPs were facilitated after repetitive electrical stimulations at short intervals (10 ms) and of weaker intensities (down to 10 microA); i.e., a temporal facilitation of the IPSPs was observed. On the other hand, large and long-lasting EPSPs which prevailed over the underlying IPSPs were evoked after repetitive electrical stimulations (a few pulses or more) at short intervals (10 ms) and of stronger intensities (generally 90 microA or more); thus, a temporal facilitation of the EPSPs was also observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1985

Pharmacological characteristics of three silent giant neurons, v-LPSN, v-1-VOrN and v-VLN, identified on the ventral surface in the left parietal and the visceral ganglia of the suboesophageal ganglia of an African giant snail (Achatina fulica Férussac).

Three giant neurons, named v-LPSN, v-1-VOrN and v-VLN, were identified on the ventral surface of the left parietal ganglion and the visceral ganglion in the suboesophageal ganglia of an African giant snail (Achatina fulica Férussac). They lacked the spontaneous spike discharges in the normal state. The pharmacological features of the three neurons, in relation to the principal common neurotransmitter substances and their derivatives were examined. The v-LPSN (ventral-left parietal silent neuron) (diameter: about 130 microns) is situated in the left parietal ganglion close to the visceral ganglion. The neuron was excited by histamine (the minimum effective concentration [MEC]: 3 X 10(-4) M) and inhibited slightly by acetylcholine (Ach) and its related substances. The v-1-VOrN (ventral-left-visceral oral neuron) (diameter: about 130 microns) is situated in the left and oral part of the visceral ganglion. The neuron was inhibited markedly by dopamine (DA) (MEC: 3 X 10(-4) M) and slightly by Ach and its related substances. No substance producing a marked excitation of the neuron has been found yet. The v-VLN (ventral-visceral large neuron) (diameter: about 300 microns) is found in the centre of the visceral ganglion. The neuron was excited by L-norepinephrine (MEC: 10(-4) M), DL-octopamine (MEC: 2 X 10(-4) M), 5-hydroxytryptamine (MEC: 10(-4) M) and beta-hydroxy-L-glutamic acid (MEC: 10(-4) M) and inhibited by DA (MEC: 10(-4) M), GABA (MEC: 3 X 10(-5) M) and Ach (MEC: 10(-4) M). L-Epinephrine showed varied effects (MEC: 10(-4) M), which were either excitatory or inhibitory.

Action Potentials↗