Unilateral Leg Swelling Caused by Common Femoral Vein Compression by a Hip Ganglion Cyst in the Groin.

BACKGROUND: As a rare cause of unilateral leg swelling, extrinsic vein compression caused by intraperitoneal, retroperitoneal, or inguinal lesions has been noted. A rare case of leg swelling as a cause of extrinsic compression of common femoral vein from a ganglion cyst in the groin is presented. CASE PRESENTATION: A 38 year old man was referred with a 3 week history of left leg swelling. Following a radiological diagnosis of common femoral vein compression from a cystic groin mass, he firstly underwent needle aspiration. Although the lesion became somewhat smaller, his left leg was still swollen, and he underwent surgical excision of the lesion 2 days after needle aspiration. Histopathological features of the cystic wall were consistent with those of a ganglion cyst. He was discharged from the hospital with complete improvement of the leg swelling, and has remained free from recurrence 1 year after surgery. CONCLUSION: Femoral vein compression by a ganglion cyst in the groin is a very rare pathology; however, it should be kept in mind in the differential diagnosis of unilateral leg swelling.

Left axillary incision (minithoracotomy) for PDA division.

From 1955 to 1975, 417 patent ductus arteriosus (PDA) operations were performed at Sapporo Medical University. The last 118 operations (28.3%) were done by division through the left axillary incision without mortality. Forty patients were less than 2 years old and 14 were less than 1 year old. The ratio of girls to boys was 3.5:1. Because the majority of patients with PDA are girls, parents commonly show considerable concern over the size of the operative scar. Our clinical experience demonstrates clearly the feasibility and safety of an axillary incision in dividing a PDA, even in premature infants. A minithoracotomy through the axilla is recommmended.

Treatment of intracranial nongerminomatous malignant germ cell tumors producing alpha-fetoprotein.

We treated 10 patients with intracranial nongerminomatous malignant germ cell tumors producing alpha-fetoprotein between 1969 and 1992. Two patients were treated with radiotherapy (RT) only (RT group), and three were treated with RT and cisplatin plus vinblastine plus bleomycin therapy with or without surgery (cisplatin plus vinblastine plus bleomycin group). The most recently treated five patients received cisplatin plus etoposide (PE) therapy with or without RT and/or surgery (PE group). The level of alpha-fetoprotein in serum was elevated in all 10 patients. In the PE group, PE therapy consisted of cisplatin (20 mg/m2) and etoposide (60 mg/m2) daily for 5 days (one course) given two or three times at 4-week intervals and then once every 4 months; the patients received three to six courses (mean, 4.2 courses). In the RT group (n = 2), one patient died 3 months after diagnosis and the other died at 12 months. In the cisplatin plus vinblastine plus bleomycin group (n = 3), complete remission was obtained in one patient, but the other two patients died 12 and 24 months after diagnosis. In contrast, in the PE group (n = 5), complete remission was obtained in all patients who are all currently alive without recurrence, at 35 to 71 months (average, 53.6 mo) after diagnosis. The results indicate that multidisciplinary treatment including combination chemotherapy with cisplatin and etoposide with or without surgery and/or RT is highly effective in the treatment of patients with alpha-fetoprotein-producing intracranial nongerminomatous malignant germ cell tumor.

Adenylate cyclase modulation of endocochlear potential during suppression of strial Na(+)-K+ ATPase.

Forskolin, an adenylate cyclase activator, produces a reversible elevation of the endocochlear potential (EP) (Doi et al., 1990a). To determine whether strial Na(+)-K+ ATPase activity is essential for the forskolin-dependent EP elevation, we examined, by means of K(+)-selective microelectrodes, the effects of forskolin on the EP and the endolymphatic K+ activity ([K+]) while strial Na(+)-K+ ATPase was suppressed by ouabain. Perilymphatic perfusion with ouabain (10(-3) M) decreased the EP from 78.5 +/- 2.4 mV to -27.6 +/- 2.4 mV (N = 8) at 37.9 +/- 3.7 min after the start of perfusion and decreased the [K+] from 138.7 +/- 5.4 mM to 103.7 +/- 3.7 mM (N = 3). Successive perfusion with forskolin (2 x 10(-4) M) with ouabain (10(-3) M) increased the EP by 15.1 +/- 1.5 mV (N = 8) but did not influence the [K+] decrease from 101 +/- 3.6 mM to 95 +/- 1.3 mM (N = 3). Forskolin (2 x 10(-4) M) with ouabain (10(-3) M) without a preceding ouabain perfusion decreased the EP from 76.2 +/- 2.3 mV to -12.9 +/- 1.8 mV (N = 6) at 65.3 +/- 2.1 min after the start of perfusion. These results indicate that adenylate cyclase can modulate the EP in the absence of strial Na(+)-K+ ATPase activity and that adenylate cyclase activation can attenuate the EP drop induced by strial Na(+)-K+ ATPase suppression.

Role of endolymphatic anion transport in forskolin-induced Cl- activity increase of scala media.

To determine the role of anion transport in the forskolin-induced Cl- increase of scala media (SM), effects of forskolin on the EP (endocochlear potential) and Cl- activity (ACl) in SM were examined with double-barrelled Cl(-)-selective microelectrodes. The experiments were carried out on guinea pig cochleae, using a few anion transport inhibitors: IAA-94 for a Cl- channel blocker, bumetanide (BU) for an Na+/K+/2Cl- cotransport blocker, and SITS and DIDS for Cl-/HCO3- exchange blockers. The application of forskolin (200 microM) into scala vestibuli (SV) caused a 20 mEq increase of endolymphatic ACl and a 15 mV elevation of EP, and IAA-94 with forskolin completely abolished these responses. Although each application of BU, SITS or DIDS did not completely suppress EP elevation, the concurrent application of these inhibitors completely suppressed EP with endolymphatic ACl increase. The results indicate the involvement of Cl- channels, Na+/K+/2Cl- cotransport and Cl-/HCO3- exchange in forskolin-induced increase of ACl and EP. The role of adenylate cyclase activation and Cl- transport in endolymph homeostasis was discussed.

Role of ATP-sensitive K+ channels in anoxia-sensitive negative potential of endolymph.

To investigate the possible role of the ATP-sensitive K+ channels (KATP channels) in the generation of the anoxia-sensitive negative potential (ASNP), the effects of the treatment with glybenclamide and diazoxide on the endocochlear potential (EP) and K+ activity (AK) in the scala media were examined with double-barrelled K(+)-selective microelectrodes. The experiments were carried out in guinea pig cochleae, using glybenclamide as a KATP channel blocker and diazoxide as a KATP channel opener. Perilymphatic perfusion of glybenclamide decreased the amplitude of the ASNP and shortened its duration, whereas perfusion of diazoxide increased ASNP amplitude and prolonged its duration. Glybenclamide enhanced the decrease of endolymphatic AK by anoxia, whereas diazoxide suppressed this AK decrease. The results suggest that KATP channels may be involved in the generation of the ASNP.

The effect of protein kinase C stimulator and inhibitor on cochlear potentials in the guinea pig.

To determine a possible role of protein kinase C (PKC) in the cochlear, the effects of a PKC stimulator (phorbol-12-myristate-13-acetate; PMA), an inactive analogue of PKC stimulator (4 alpha-phorbol-12,13-didecanoate; 4 alpha-PDD) and a PKC inhibitor (D-sphingosine) on cochlear potentials were examined in the guinea pig. The perilymphatic perfusion with PMA (3 x 10(-6) M) produced an increase in compound action potential (CAP) amplitude and no change in N1 latency, the amplitudes of negative summating potential (-SP), cochlear microphonics (CM) and endocochlear potential (EP). The perfusion with 4 alpha-PDD (3 x 10(-6) M) did not change the sound-evoked cochlear potentials and the EP. The perfusion with D-sphingosine (10(-5) M) produced a decrease in CAP amplitude and no change in N1 latency and the amplitudes of -SP, CM and EP. The results suggest that PKC may be involved in the mechanism underlying the CAP generation.

Involvement of Cl- transport in forskolin-induced elevation of endocochlear potential.

To determine the possible involvement of Cl- transport in the forskolin-induced endocochlear potential (EP) elevation, the effect of forskolin on the EP was examined in Cl(-)-free artificial perilymph (aPL) as well as in the presence of Cl- channel blockers. The perfusion of scala vestibuli (SV) with forskolin (200 microM) dissolved in Cl(-)-free aPL failed to produce an EP elevation, while SV perfusion of forskolin dissolved in normal aPL elevated the EP. The application of DPC and IAA-94 (blockers of cAMP-activated Cl- channel) into SV completely suppressed the forskolin-induced EP elevation, while niflumic acid (a Ca(2+)-activated Cl- channel blocker) failed to do so. IAA-94 applied into scala tympani (ST) did not suppress this EP elevation. The results suggest that adenylate cyclase may modulate the EP by changing Cl- transport between SV and scala media (SM) across Reissner's membrane.

Failure of forskolin to elevate the endocochlear potential in kanamycin-poisoned animals.

The effect of forskolin (FSK) on the endocochlear potential (EP), K+ activity (AK), Na+ activity (ANa) and Cl- activity (ACl) in scala media (SM) was compared between normal and kanamycin (KM)-poisoned guinea pigs by means of double-barrelled ion-selective microelectrodes. The perfusion of the scala vestibuli (SV) with FSK (200 microM) produced EP elevation in normal animals whereas FSK failed to do it in KM-poisoned animals. FSK increased ACl of SM with no significant change in AK and ANa of SM in both groups of animals. Histological examination of KM-poisoned animals showed damaged outer and inner hair cells with an intact appearance of the stria vascularis. The mechanism underlying the failure of FSK to elevate the EP in KM-poisoned animals is discussed.

Isolated oculomotor nerve palsy following midbrain infarction.

A 62 year-old male patient presented with isolated oculomotor nerve palsy following a small infarction of the medial ventral midbrain, documented by magnetic resonance imaging. There was a 12-year history of hypertension, but no diabetes mellitus. Angiography revealed atherosclerosis of the paramedian mesencephalic arteries. Magnetic resonance imaging may be useful in patients with small brain stem infarctions.

Primary intracranial plasma-cell granuloma: a case report and review of the literature.

BACKGROUND: Plasma-cell granulomas, which are characterized by the non-neoplastic proliferation of plasma cells, are primarily found in the lungs and upper respiratory tracts, and are extremely rare in the central nervous system. METHODS: An intracranial tumor of an 11-year-old boy was evaluated by histologic and radiologic examination. RESULTS: An 11-year-old boy had a 2-month history of mild headache and nausea. A computed tomography scan showed a round, slightly high-density mass surrounded by marked edema in the left frontal lobe. On magnetic resonance imaging (MRI), the mass had a slightly high signal intensity on the T1-weighted image and marked low signal intensity on the T2-weighted image. It was heterogenously enhanced with gadolinium-DTPA. Microscopic examination demonstrated a non-neoplastic mixed cell population with a predominance of plasma cells. Immunohistochemical staining revealed that it was characterized by a polyclonal plasma cell population. CONCLUSION: Our extensive search of the literature indicated this to be the ninth reported case of intracranial plasma cell granulation. The MRI was very useful for evaluating the extent of the intracranial lesions. The tumor was removed surgically and did not recur during a 2-year follow-up with no radiation therapy.

Arachnoid cyst in the quadrigeminal cistern.

Two cases of arachnoid cysts in the quadrigeminal cistern are presented, and one occurred in an adult. Signs and symptoms of increased intracranial pressure were noted, and obstructive hydrocephalus was shown by computed tomography scans in both cases. Arachnoid cysts in the quadrigeminal cistern have rarely been reported, especially in adults. The definition, classification, and etiology of arachnoid cyst are still confused in the literature, and various terms have also been used to indicate this particular location of cyst. In this study, these confusing problems are reviewed, and the usefulness of metrizamide computed tomographic cisternography is emphasized as a noninvasive method of diagnosis.

Ca(2+)-dependent inhibition of inwardly rectifying K(+) channel in opossum kidney cells.

The effect of intracellular Ca(2+) on the activity of the inwardly rectifying ATP-regulated K(+) channel with an inward conductance of about 90 pS was examined by using the patch-clamp technique in opossum kidney proximal tubule (OKP) cells. The activity of the inwardly rectifying K(+) channel rapidly declined with an application of ionomycin (1 microM) in the presence of 10(-6) M Ca(2+) in cell-attached patches. The application of 10 microM phorbor-12-myristate-acetate (PMA) with 10(-6) M Ca(2+) reduced the K(+) channel activity. Although the channel activity was not influenced by an increase of bath Ca(2+) from 10(-7.5) to 10(-6) M, the activity was inhibited by protein kinase C (PKC, 1 U/ml) with 10(-6) M Ca(2+) in inside-out patches. The inhibitory effect of Ca(2+) with ionomycin on the channel activity was diminished by the pretreatment with a specific PKC inhibitor, GF 109203X (5 microM), in cell-attached patches. By contrast, the application of Ca(2+)/calmodulin kinase II (CaMK II, 300 pM) dramatically increased this channel activity in inside-out patches. In cell-attached patches, the addition of both GF 109203X and cyclospolin A (5 microM), a potent inhibitor of protein phosphatase 2B (calcineurin), instead stimulated the K(+) channel activity with ionomycin and 10(-6) M Ca(2+). The addition of protein phosphatase 2B (calcineurin) (2 U/ml) to the bath with calmodulin (1 microM) and Ni(2+) (10 microM) to stimulate calcineurin inhibited the channel activity in inside-out patches. Furthermore, the inhibitory effect of PKC or calcineurin on this channel activity was abolished by a removal of Ca(2+) from bath solution. These results suggest that Ca(2+)-dependent inhibitory effect on the inwardly rectifying K(+) channel in OKP cells was mainly mediated by Ca(2+)-PKC-mediated phosphorylation, and that the Ca(2+)-calmodulin-dependent phosphorylation process may be counterbalanced by the Ca(2+)-calmodulin-dependent dephosphorylation process.

The outcome of long-term follow-up after palatoplasty.

The speech outcome was studied retrospectively in 140 cleft-palate patients who underwent push-back palatoplasty. Velopharyngeal function and articulation disorders were evaluated serially at 4, 7, 10, and more than 10 years of age. On comparison of velopharyngeal function between 4 years of age and the most recent review (>10 years), it was unchanged in 90 patients (64.3 percent), whereas it showed deterioration in 14 patients and showed improvement in 8 patients. The other 28 patients underwent pharyngeal flap surgery; this group also included patients with functional deterioration. Changes of velopharyngeal function often occurred between 4 and 7 years of age but sometimes occurred after 10 years of age. Articulation disorders were observed in 49 subjects (35.0 percent) at 4 years of age. Many of the patients with glottal stop showed improvement from 4 to 7 years of age. Palatalized articulation showed less improvement than glottal stop (p < 0.01). The number of patients with articulation disorders decreased significantly between 4 years of age and the most recent review (p < 0.001). These findings suggest that speech does not become stable before 10 years of age and that patients with cleft palate should be carefully followed until they are beyond this age.

Quantitative assessment of peripheral occlusive arterial diseases by color duplex sonography and blood endothelin level.

UNLABELLED: To evaluate peripheral occlusive diseases quantitatively, we performed color duplex sonography and measured the blood endothelin (ET-1) level. MATERIALS AND METHOD: We measured the systolic velocities of the dorsal pedial and the posterior tibial arteries as well as the brachial artery. We also calculated the flow volume, and the ratio of systolic velocities and flow volume of the lower to upper extremity (AVI, AFI). Furthermore we measured the blood ET-1 level and investigated the relationship between this value and clinical symptoms. RESULTS: The value of AVI as well as AFI decreased in the order of Fontaine class I, II, III and IV. In four limbs with a Fontaine class greater than II with a normal ankle pressure index, the values of AVI were low. On the other hand, three limbs with normal values of peak-AVI (> 0.9) and lower API (< 0.75) were in Fontaine class I. The value of the ET-1 level was higher in Fontaine class III and IV than in class II, and decreased after revascularization along with improvement of clinical symptoms. CONCLUSIONS: The new AVI and AFI values showed a better correlation with clinical symptoms than API. The ET-1 level was significantly higher in Fontaine class III and IV, and showed marked regression after arterial reconstruction. Thus, the new AVI and AFI values may provide a novel means of identifying patients with the peripheral occlusive diseases, and the measurement of ET-1 level may be potentially useful in identifying the severity of arteriosclerosis.

Extra-anatomical bypass with EPTFE graft for residual pulmonary artery stenosis in Tetralogy of Fallot.

We describe the case of 35-year old woman who had undergone radical surgery to correct Tetralogy of Fallot malformation at the age of nine admitted to our hospital because of palpitation and exertional dyspnea. Angiography revealed 90% re-stenosis of the right pulmonary artery and grade IV tricuspid regurgitation. Right lung was perfused only 16.7% as shown by pulmonary perfusion scintigraphy. Interposition between the pulmonary trunk and right pulmonary artery using an EPTFE graft and tricuspid annuloplasty using a Duran ring was performed. Blood flow to the right lung improved markedly from 16.7% to 37.0% and her symptom disappeared completely.

Leriche syndrome. Surgical procedures and early and late results.

During the past thirteen years, 29 patients underwent surgical intervention for Leriche syndrome. Fifteen patients (aged forty-two to seventy-two years, average 60.7 years) underwent anatomical bypass, and 9 of them whose thrombus was confined to the infrarenal aorta received a routine graft insertion. In the other 6 whose thrombus extended to the level of the renal arteries, an open thrombectomy of the juxtarenal aorta was first performed through a transection of the infrarenal aorta under renal ischemia (4-14 minutes, average 7). Twelve elderly or high-risk patients (aged sixty-eight to eighty-four years, average 75.3 years) underwent an axillobifemoral bypass, and another 2 (fifty-eight and sixty years old, respectively) who had been operated on at an earlier time received an ascending aortobifemoral bypass. In cases of anatomical bypass, no graft has occluded and all patients but 1, who died of cerebral infarction, have an active life now. In cases of extraanatomical bypass, 5 of the 28 grafts occluded and only 6 patients have survived. The other 8 patients died of malignancy, atherosclerotic complications, or unknown causes. The 10-year survival rate was 92.9% and 29.5% in the anatomical bypass and extraanatomical bypass group, respectively. In Leriche syndrome, anatomical bypass is preferred to extraanatomical bypass if conditions permit. In the juxtarenal type, an open thrombectomy under renal ischemia is mandatory for anatomical bypass, and a transection of the infrarenal aorta facilitates this procedure. Because the patients with Leriche syndrome are elderly and harbor arteriosclerotic lesions, a careful follow-up is mandatory.

Effect of endoplasmic Ca2+-ATPase inhibitors on cochlear potentials in the guinea-pig.

The effect of endoplasmic Ca2+-ATPase inhibitors on cochlear potentials was examined in the guinea-pig. Perilymphatic perfusion with thapsigargin (10[-6] M) produced a significant decrease in the amplitudes of cochlear microphonics, negative summating potential and compound action potential, and a significant prolongation of N1 latency with no change in the endocochlear potential. These changes were all dose dependent. Another endoplasmic Ca2+-ATPase inhibitor, cyclopiazonic acid (10[-5] M), produced the same effects as thapsigargin on cochlear potentials. These results suggest that endoplasmic Ca2+-ATPase inhibitors may have inhibitory functions on cochlear potentials.

Carotid and vertebral rete mirabile in man--case report.

Rete mirabile is a normal vascular network in the carotid artery distribution of some vertebrates, but is an abnormal and extremely rare finding in humans. We describe a 40-year-old male with a carotid and vertebral rete mirabile manifesting as cerebrovascular disorder. This was the second case of carotid and vertebral rete mirabile in man.

Large encephalocele at the anterior fontanel--case report.

The authors report a newborn girl with a large meningoencephalocele, 18.5 cm in diameter, at the anterior fontanel. She had several accompanying anomalies, including microcephalus, cleft palate, and a uvula bifida. A plain skull x-ray revealed craniolacunia and a computed tomography (CT) scan showed maldevelopment of the cerebrum. The mass was resected, after which the fontanel was noted to bulge. CT demonstrated dilated lateral ventricles. A successful shunting procedure permitted the infant to leave the hospital in good general condition.