[Infantile optic glioma involving the whole optic pathway--a case report].

A case of infantile optic glioma involving the whole optic pathway is reported. The patient was a 4-month-old female. The mother noticed that the baby could not follow the object, although her physical development had been apparently normal only until three months after birth. On admission, she was lethargic, although no definite motor weakness was identified. The ophthalmological check revealed delayed bilateral pupillary light reaction and choked disks. Skull X-ray film showed the J-shaped sella and the enlarged bilateral optic canals. CT scan also revealed an isodensity mass in the suprasellar cistern and enlarged bilateral optic nerves. The lesions were enhanced homogeneously with contrast medium and extended toward both optic radiations. Lateral ventricles were mildly dilated. Cerebral angiography showed the upward shift of A1-portion of the bilateral anterior cerebral arteries and the backward shift of the basilar artery. No abnormal vessels were visible. A bifrontal craniotomy was performed to partially remove the suprasellar tumor. The histological diagnosis was optic glioma. The postoperative course was uneventful. The patient was discharged without any neurological deficits except poor visual acuity. Four months later, she suddenly fell into generalized convulsion. CT scan revealed the significant enlargement of residual tumor and ventricular dilatation. Surgical treatment of VP shunt was immediately performed on, and then irradiation of 4,000 rad of total dose to the tumor followed. The tumor size became definitively small. On a follow-up term of 15 months, the patient has been doing well.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of echograms by a microscanner and histological findings of the common bile duct, in vitro study].

To confirm the relationship between the layer structure of the common bile duct by a microscanner (MS) and its histological features, we performed a study using the pinning method with needles and catgut. The locations of 67 needles inserted at random depths in 29 slices of the resected common bile duct from 18 patients were confirmed both by a MS and a microscope. The wall of the common bile duct was delineated as a two- (42 points) or three-layer structure (25 points); "low and high" or "high, low, and high echoic layers" from the mucosal side. A fibrotic layer (ss 1) was often (56/67 points, 16/18 patients) seen in the subserosa (ss) containing nerves and vessels larger than 100 mu in diameter. Among the 51 needle echoes demonstrated in the inner hypoechoic layer, 2 were located in the mucosa (m), 12 in the fm, 19 in the af, 17 in the ss 1, and 1 in the fatty layer of the ss (ss 2). Five of the 6 needles in the outer hyperechoic layer were in the ss 2, and 1 was in the pancreatic parenchyma (pa). Four of the 8 needles at the border between the inner hypoechoic layer and the outer hyperechoic layer histologically corresponded to fm, af, ss 1, and pa, respectively, and the other four corresponded to ss 2. From these results, we conclude that the inner hypoechoic layer contains not only m, fm, and af, but also ss 1. Therefore, this should be kept in mind for the preoperative assessment of the depth of bile duct carcinoma by MS.

Diffusion of cytotoxic concentrations of nitric oxide generated luminally at the gastro-oesophageal junction of rats.

BACKGROUND: In humans, high concentrations of nitric oxide are generated luminally at the gastro-oesophageal junction through enterosalivary recirculation of dietary nitrate. AIM: To investigate whether luminal nitric oxide can diffuse into the adjacent digestive tissue and alter tissue integrity. METHODS: We designed an animal model using Wistar rats in which physiological concentrations of nitrite and acidified ascorbic acid were administered separately so that the two reactants first meet to form nitric oxide at the gastro-oesophageal junction. Luminal and tissue concentrations of nitric oxide were measured with an electrode and an electron paramagnetic resonance spectrometer, respectively. Concentrations of glutathione in the tissue were measured as a marker of nitrosative stress. RESULTS: High concentrations of luminal nitric oxide were generated locally at the gastro-oesophageal junction of nitrite administered rats, reproducing a phenomenon observed in humans. High levels of nitric oxide were also detected largely in the superficial epithelium of the gastro-oesophageal junction. The concentration of tissue glutathione at the gastro-oesophageal junction was significantly lower in nitrite administered rats compared with control rats, whereas that in the distal stomach was similar in the two rat groups. CONCLUSIONS: Using an animal model, this study demonstrated that nitric oxide generated in the lumen diffuses into the adjacent gastric tissue to a substantial degree, leading to localised consumption of glutathione in the tissue. Nitrosative stress induced by this mechanism may be involved in the high prevalence of inflammation and metaplasia, and subsequent development of neoplastic disease at this site.

Prediction of prognosis in open-heart-surgery by regional difference in leg surface temperature.

Change of the surface temperature of the leg during open-heart-surgery was determined in five patients, in whom either side of the femoral artery was ligated for cannulation. While the surface temperature at the patella was least influenced, that at the ankle paralleled closely the changes in the core body temperature and blood supply to the leg. Their difference (P-A difference) was studied to see if they can be used to predict prognosis of patients undergoing open-heart surgery. The P-A difference was followed for several hours after the open-heart surgery. It was marked positive when the surface temperature at the patella was higher than that at the ankle. Total of 54 patients were studied. Only one out of 29 patients with negative P-A difference succumbed. This is in sharp contrast to the 25 remaining patients with positive P-A difference, from whom as many as 12 died. In addition, the postoperative course of the 13 survivors from the latter group was more eventful. Since P-A difference seemed to indicate accurately cardiac output by reflecting the state of the peripheral circulation, it can be used as a useful parameter in prediction of the prognosis in open-heart surgery.