Unilateral Partial Absence of the Fallopian Tube in a Female Patient With Infertility: A Case Report and Literature Review.

Unilateral partial absence of the fallopian tube is rare, and its clinical importance in fertility is unclear. A 35-year-old nulligravid female patient with infertility was suspected to have a left hydrosalpinx on hysterosalpingography and sonography. Therefore, the patient underwent diagnostic laparoscopy. The left fallopian tube lacked the ampullary portion, and its proximal end had a hydrosalpinx. A left salpingectomy was performed, and the pathological finding was a unilateral partial absence of the ampullary portion of the fallopian tube with hydrosalpinx. Postoperatively, she conceived via in vitro fertilization-embryo transfer-and delivered a healthy baby. Hydrosalpinx is a well-known cause of infertility and can develop due to the partial absence of a fallopian tube. Furthermore, salpingectomy may be effective in improving fertility in female patients with a unilateral partial absence of the fallopian tube.

Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis.

Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient's jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.

Rectal arterio-venous malformation (AVM) with bleeding of an internal hemorrhoid.

A 38-year-old male with no past history of illnesses visited the out-patient clinic of Nerima Hikarigaoka Hospital complaining of dizziness and persistent anal bleeding. There was a significant anemia on a blood test and colonoscopy showed a thrombus in a markedly swollen internal hemorrhoid. Contrast-enhanced computed tomography (CT) showed a poorly demarcated area with early face enhancement on the right side of the rectum and anal canal. Based on these findings, an arterio-venous malformation (AVM) of the rectum was suspected. Abdominal angiography showed abnormal vessels receiving a blood supply from the bilateral superior rectal arteries. We suspected that the AVM in the rectum was the cause of the hemorrhage from the internal hemorrhoid, and therefore performed embolization of the AVM. Thereafter, the hemorrhage from the internal hemorrhoid stopped completely and the anemia improved to the normal level, without the need for treatment for the internal hemorrhoid. Colonoscopy performed 6 months after embolization showed shrinkage of the internal hemorrhoid. To the best of our knowledge, there are no reports stating a relationship between rectal AVM and internal hemorrhoids. However, we consider that contrast-enhanced CT can be used to detect vessel abnormalities related to severe bleeding of the internal hermorrhoids in patients with internal hemorrhoids and severe anemia.

Relationship between perceived exertion and blood lactate concentrations during incremental running test in young females.

BACKGROUND: To investigate more practical handling of Borg's ratings of perceived exertion (RPE) and category-ratio scale of RPE (CR-10), we evaluated interrelationships between RPE, CR-10, and blood lactate concentrations (bLa) during incremental treadmill running tests for young females with different aerobic fitness levels. METHODS: Oxygen consumption, heart rate, bLa, RPE, and CR-10 were measured from distance runners (DR; n = 15), race walkers (RW; n = 6), and untrained females (UT; n = 11). These variables corresponding to the lactate threshold (LT) and onset of blood lactate accumulation (OBLA) were compared among these groups. RESULTS: The UT had significantly lower RPE at LT than DR and RW, although the CR-10 at LT was not significantly different among these groups. The CR-10 at OBLA was significantly lower for the UT than DR. The relationship between bLa and CR-10 was approximated well by two linear regression lines in all groups. The bLa at the intersection only for the RW was significantly lower than that at LT, however, such intersections were observed at CR-10 = 3.1 to 3.2 without significant group differences. The CR-10 scores at LT and intersections were not significantly different in each group. CONCLUSION: These results suggested that an intersection between CR-10 and bLa was observed at the CR-10 score around three points of first half regardless of the aerobic fitness levels in young females, and such CR-10 scores would be associated with LT.

Adenocarcinoma arising from an anal gland-Report of a case.

INTRODUCTION: Adenocarcinoma arising from an anal gland is extremely rare. Most anal canal cancers are squamous cell carcinoma, and adenocarcinoma is infrequently diagnosed. Diagnostic criteria and the standard treatment for adenocarcinoma of the anal canal have not been clearly defined, in part because of the rarity of this lesion. PRESENTATION OF CASE: An 84-year-old man who presented with a piece of tissue prolapsing from the anus. An incisional biopsy showed adenocarcinoma, and an abdomino-perineal resection was then performed. Cytokeratin 7 (CK7), cytokeratin 19 (CK19) stained positive in the specimen, suggesting that the tumor developed from an anal gland. The patient was discharged after surgery without any complications. DISCUSSION: Exact diagnostic criteria for adenocarcinoma of the anal canal have not been previously described. In the present case, CK7 and CK19 were stained, and the tumor showed positivity for both of these markers, which is compatible with the staining patterns of anal gland origin cancer. Radical resection is recommended rather than local resection, because of the tumor's high recurrence rate. Some authors recommend combined modality treatment with preoperative or postoperative chemoradiotherapy because of the high rate of distant recurrence. CONCLUSION: The preoperative diagnosis of adenocarcinoma arising from an anal gland is not easily established. However, it may be possible to suspect an anal glandular adenocarcinoma based on a meticulous physical examination, appropriate diagnostic studies and pathological findings on biopsy.

VO2 response at the onset of heavy exercise is accelerated not by diathermic warming of the thigh muscles but by prior heavy exercise.

We investigated whether the elevated muscle temperature induced by the first bout influenced the VO2 response during a second-bout of heavy exercise. The control conditions were two consecutive 6-min leg cycling bouts (work rate: Δ50% between LT and VO2max) separated by a 6-min baseline at 20 W (L1-ex to L2-ex). In the experimental conditions prior to the main bout (H2-ex), the diathermic warming to the front thigh was substituted for the first-bout. The VO2 response for the second bout was significantly accelerated compared with the first bout (mean ± SD of the τ by monoexponential fitting: L1-ex: 53.8 ± 11.6, L2-ex: 38.7 ± 7.9 s, P < 0.05). The diathermic warm-up, however, could not accelerate VO2 response for subsequent supra-LT leg exercise (τ for H2-ex: 52.3 ± 7.7 s). It was concluded that the facilitation of [VO2 response during supra-LT exercise after prior heavy exercise does not seem to be caused by increased muscle temperature per se and its related factors.

Early gastric cancer combined with multiple metachronous osteosclerotic bone and bone marrow metastases that responded to chemoradiotherapy.

We report a 75-year-old woman who suffered multiple metachronous osteosclerotic bone metastases 4 years after a distal gastrectomy for early gastric cancer (EGC). The primary tumor was a poorly differentiated adenocarcinoma, which had invaded the submucosal layer, and only one lymph node metastasis was noted. To the best of our knowledge, cases of EGC combined with metachronous osteosclerotic multiple bone and bone marrow metastases that respond to chemoradiotherapy are very rare. In this case, the multiple bone metastases were diagnosed 4 years after surgery. The patient's metastatic tumor was successfully treated using S-1, paclitaxel, and camptothecin, with subsequent irradiation. The patient survived for 24 months after the treatment, without having any major symptoms.

Effects of femoral vascular occlusion on ventilatory responses during recovery from exercise in human.

We investigated the effect of occluding of femoral blood flow on the post-exercise ventilatory response of both the sub- and supra-anaerobic threshold (AT) leg cycling in humans. Seven healthy subjects (aged 21-44 years) volunteered to participate in this study. The protocol consisted of 6 min constant-load upright cycling at either a sub-AT (80% of AT) or supra-AT (midway between AT and VO(2)max) work rate and a subsequent 6 min rest period either with or without femoral blood flow being occluded by a rapid cuff inflation to 250 Torr during the first 2 min of recovery. Blood lactate levels at the cessation of the sub- and supra-AT exercise averaged 1.8+/-0.2 and 4.9+/-0.4 mequiv.l(-1) (mean+/-S.E.M.), respectively. Compared to spontaneous recovery, the circulatory occlusion significantly reduced ventilation irrespective of the intensity of the preceding exercise. The relative contribution of the ventilatory deficit to the total spontaneous ventilation (defined as the difference between the cumulative ventilation with and without cuff inflation during the first 2 min of recovery) was significantly greater supra-AT (18.0+/-3.9%) than sub-AT (9.3+/-2.9%, P<0.05). The subsequent release of occlusion was accompanied by a rapid increase in ventilation that began on the first breath after release. We concluded that the relatively greater speeding of ventilatory decline with occlusion during the first 2 min of recovery from supra-AT exercise argues against a significant role for an intramuscular chemoreflex-induced hyperpnoea. Rather, mechanisms related to the hemodynamic effects of suddenly altered muscle perfusion seem more consistent with this phenomenon.

Differential sympathetic outflow and vasoconstriction responses at kidney and skeletal muscles during fictive locomotion.

We compared sympathetic and circulatory responses between kidney and skeletal muscles during fictive locomotion evoked by electrical stimulation of the mesencephalic locomotor region (MLR) in decerebrate and paralyzed rats (n = 8). Stimulation of the MLR for 30 s at 40-microA current intensity significantly increased arterial pressure (+38 +/- 6 mmHg), triceps surae muscle blood flow (+17 +/- 3%), and both renal and lumbar sympathetic nerve activities (RSNA +113 +/- 16%, LSNA +31 +/- 7%). The stimulation also significantly decreased renal cortical blood flow (-18 +/- 6%) and both renal cortical and triceps surae muscle vascular conductances (RCVC -38 +/- 5%, TSMVC -17 +/- 3%). The sympathetic and vascular conductance changes were significantly dependent on current intensity for stimulation at 20, 30, and 40 microA. The changes in LSNA and TSMVC were significantly less than those in RSNA and RCVC, respectively, at all current intensities. At the early stage of stimulation (0-10 s), decreases in RCVC and TSMVC were significantly correlated with increases in RSNA and LSNA, respectively. These data demonstrate that fictive locomotion induces less vasoconstriction in skeletal muscles than in kidney because of less sympathetic activation. This suggests that a neural mechanism mediated by central command contributes to blood flow distribution by evoking differential sympathetic outflow during exercise.

Renal sympathetic and circulatory responses to activation of the exercise pressor reflex in rats.

We investigated the role played by the exercise pressor reflex in sympathetic regulation of the renal circulation in rats. In mid-collicular decerebrate rats, mean arterial pressure (MAP), heart rate (HR), left renal cortical blood flow (RCBF) and left renal sympathetic nerve activity (RSNA) were recorded before and during 30 s of static contraction of the left triceps surae muscles evoked by electrical stimulation of the tibial nerve, which activates both metabo- and mechanosensitive muscle afferents, and during 30 s of passive stretch of the left Achilles tendon, which selectively activates mechanosensitive muscle afferents. Static contraction (n = 17, +344 +/- 34 g developed tension) significantly (P < 0.05) increased MAP (+14 +/- 3 mmHg), HR (+6 +/- 1 beats min(-1)) and RSNA (n = 11, +19 +/- 5%) and significantly decreased renal cortical vascular conductance (RCVC, n = 11, -11 +/- 2%). Passive stretch (n = 20, +378 +/- 11 g) also significantly increased MAP (+11 +/- 2 mmHg), HR (+7 +/- 2 beats min(-1)) and RSNA (n = 15, +14 +/- 4%) and significantly decreased RCVC (n = 11, -12 +/- 3%). RCBF showed no significant changes during static contraction or passive stretch. Renal denervation abolished the decrease in RCVC during contraction (n = 12) or stretch (n = 13). These data indicate that both the exercise pressor reflex and its mechanically sensitive component, the muscle mechanoreflex, induced renal cortical vasoconstriction through sympathetic activation in rats.

Assessment of short-distance breaststroke swimming performance with critical velocity.

For high-velocity running or swimming, the relationship between velocity (v) and its sustainable duration (t) can be described by a hyperbolic relationship: (v - Vcrit)·t = D', where Vcrit is termed critical velocity, and D' is defined as a curvature constant of the hyperbolic curve. The purposes of this study were to examine whether the Vcrit could be applied to evaluate short-distance breaststroke swimming performance and to evaluate the relative contribution of D' in short-distance swimming performance. Eleven male swimmers performed a series of time trials corresponding to 75, 100, and 150-m in an indoor 50-m swimming pool. The observed records were calculated into average velocities of each event to determine Vcrit and D'. After the determination of Vcrit and D', all subjects performed 50-m time trial on another day. A maximal anaerobic power test using cycle ergometer was also performed in the laboratory. The average velocity of the 50-m time trial significantly correlated with the obtained Vcrit, but not with D'. D' was significantly correlated with the residual error, calculated from the regression analysis for the relationship between Vcrit and the average velocities of 50-m time trial. A cluster analysis showed that most of the subjects were classified as Vcrit dependency when performing 50-m time trial. Those results indicated that Vcrit could be applied to evaluate short-distance swimming performance, and it determined around 80% of the short-distance breaststroke swimming performance. Key PointsFor high-velocity running or swimming, the relationship between velocity (v) and its sustainable duration (t) can be described by a hyperbolic relationship: (v - Vcrit)·t = D', where Vcrit is termed critical velocity, and D' is defined as a curvature constant of the hyperbolic curve. The D' contributed only around 20% of the breaststroke swimming performance even in a short-distance event.Critical velocity determined around 80% of 50-m breaststroke swimming performance, and it could be a useful tool for evaluating short-distance swimming performance.Most of the swimmers showed characteristics for critical velocity dependent physical fitness even in short-distance swimming event.

Sympathetically induced renal vasoconstriction during stimulation of mesencephalic locomotor region in rats.

Central command, which is a neural drive originating in the brain during exercise, regulates the sympathetic nervous system and evokes cardiovascular responses to exercise. To examine the role of the central command on sympathetic regulation of renal circulation, we compared responses in renal cortical blood flow and vascular conductance to electrical stimulation of mesencephalic locomotor region (MLR) for 30 s in decerebrate and paralyzed rats between renal nerves that were intact (n=8) and denervated (n=8). In rats with renal nerves intact, stimulation of the MLR at 40 microA current intensity significantly (p<0.05) decreased renal cortical blood flow (-17+/-5%, means+/-S.E.M.) and vascular conductance (-43+/-4%) and the decrease in renal vascular conductance was dependent on current intensity (between 20 and 60 microA). In renal denervated rats, in contrast, there were no significant changes in either renal cortical blood flow or vascular conductance during stimulation at all current intensities. In a subset of rats (n=8), the response in renal sympathetic nerve activity to 30 s stimulation of the MLR was investigated. Stimulation of the MLR significantly increased renal sympathetic nerve activity (+57+/-14% at 40 microA) and the response was dependent on current intensity (between 20 and 60 microA). These data provide evidence that central command induces renal vasoconstriction by increasing sympathetic activity, depending on central command intensity.

Disuse atrophy increases the muscle mechanoreflex in rats.

We investigated the effect of disuse atrophy on the magnitude of the muscle mechanoreflex. The left leg of eight rats (6-7 wk, male) was put in a plaster cast for 1 wk. The rats were decerebrated at the midcollicular level. We recorded the pressor and cardioaccelerator responses to 30-s stretch of the calcaneal tendon, which selectively stimulated the muscle mechanosensitive receptors in the left atrophied and right control triceps surae muscles. Atrophied muscles showed significantly lower mass control muscles (1.0 +/- 0.1 vs. 1.4 +/- 0.1 g; P < 0.05). At the same stretch tension (229 +/- 20 g), the pressor response to stretch was significantly greater in the atrophied muscles than in the control muscles (13 +/- 3 vs. 4 +/- 2 mmHg, P < 0.05). The cardioaccelerator response was not significantly different (8 +/- 4 vs. 4 +/- 2 beats/min). Comparing responses at the same relative tension (57 +/- 6 vs. 51 +/- 8% of maximal tension), the pressor response was still significantly greater in the atrophied triceps surae than in the control (14 +/- 4 vs. 4 +/- 2 mmHg; P < 0.05). These results suggest that disuse atrophy increases the magnitude of muscle mechanoreflex.

Biclonal extramedullary plasmacytoma arising in the peritoneal cavity: report of a case.

We report a rare case of extramedullary plasmacytoma, which arose either in the ileum or the ileal mesentery. A 70-year-old woman presented with a high fever and symptoms of bowel obstruction. Computed tomography and magnetic resonance imaging showed a large heterogeneous tumor in the peritoneal cavity. Serum immunoelectrophoresis revealed a biclonal increase of IgA-Kappa and IgG-Kappa. At surgery, we found that the parenchyma of the fragile tumor had firm communication with the ileal mesentery, and the cavity of the tumor communicated with the ileal lumen. After a temporary regression following surgery and chemotherapy, the tumor grew rapidly. Although there was no evidence of progression to multiple myeloma, the patient died of cachexia less than 4 months after surgery.

Pressor response to static and dynamic knee extensions at equivalent workload in humans.

Static exercise has been thought to induce greater pressor response than dynamic exercise, but in contrast it has been recently reported that repetitive muscle contraction recruiting small muscles evokes greater response than sustained contraction. It remained unknown whether sustained contraction induces greater pressor response if large muscles were recruited. Nine subjects performed three types of isometric knee extensions recruiting the large muscle group, i.e., 2-min sustained (20% and 40% maximal voluntary contraction [MVC]) and 4-min repetitive (40% MVC, duty cycle = 1:1 s) muscle contractions. Compared under the equivalent TTI and exercising duration (2 min), the changes in femoral arterial blood flow and VO(2) from baseline (Delta BF, Delta VO(2)) were significantly less during sustained contraction than during repetitive contraction (sustained vs. repetitive; Delta BF: +92 +/- 195 vs. +1,174 +/- 269 ml.min(-1), Delta VO(2): +53 +/- 12 vs. +180 +/- 32 ml.min(-1), mean +/- SE, p < 0.05), although the change in mean arterial pressure (Delta MAP) was greater during sustained contraction (+24 +/- 3 vs. +19 +/- 3 mmHg). Compared under the equivalent TTI and peak tension (40% MVC), Delta BF and Delta VO(2) were less and Delta MAP was greater during sustained contraction (Delta BF: -296 +/- 176 vs. +868 +/- 272 ml.min(-1); Delta VO(2): +104 +/- 16 vs. + 212 +/- 46 ml.min(-1); Delta MAP: +37 +/- 8 vs. +20 +/- 4 mmHg). Moreover Delta MAP during postexercise occlusion of the active limb was significantly greater after sustained contraction than after repetitive contraction (+17.0 +/- 2.8 vs. +9.5 +/- 4.4 mmHg). These results demonstrated that pressor response is greater during sustained than during repetitive contraction, recruiting a large muscle group. This finding should be mainly due to the greater accumulation of metabolites in active muscles during sustained contraction.

The effect of muscle contraction velocity on cardiorespiratory responses to repetitive isokinetic exercise in humans.

We investigated the effect of muscle contraction velocity on cardiorespiratory responses during exercise. Eight males (23 +/- 2 years, 175 +/- 5 cm, 64 +/- 6 kg, mean +/- SD) performed 3-min repetitive one-leg extension exercises at various angular velocities (30, 60, 120, and 240 deg/s) with a controlled relaxation interval, relatively constant (duty cycle = 1:1, A trial) and absolutely constant (relaxation time = 0.75 s, B trial) at a total work of 2,100-2,400 J in an isokinetic mode, using a Cybex II dynamometer. We measured heart rate (HR), mean blood pressure (MAP), minute ventilation (Vdot;E), and oxygen uptake (Vdot;O(2)) during the exercise. The angular velocity significantly affected the increase in HR, MAP, Vdot;E, and Vdot;O(2) at the end of exercise from resting in both A and B trials (e.g., MAP: 12 +/- 2, 10 +/- 2, 11 +/- 2, and 18 +/- 2 mmHg in the A trial). The result suggests that muscle contraction velocity affects cardiorespiratory responses during repetitive isokinetic exercise.

The rate of phosphocreatine hydrolysis and resynthesis in exercising muscle in humans using 31P-MRS.

Time-resolved 31-phosphorus nuclear magnetic resonance spectroscopy (31P-MRS) of the biceps femoris muscles was performed during exercise and recovery in six healthy sedentary male subjects (maximal oxygen uptake; 46.6 +/- 1.7 (SEM) ml.kg-1.min-1), 5 male sprinters (56.2 +/- 2.5), and 5 male long-distance runners (73.6 +/- 2.2). Each performed 4 min of knee flexion exercises at absolute values of 1.63 W and 4.90 W, followed by 5 min of recovery in a prone position in a 2.1 T superconducting magnet with a 67 cm bore. 31P-MRS spectra were recorded every 12.8 s during the rest-exercise-recovery sequence. Computer-aided contour analysis and pixel imaging of phosphocreatine peaks (PCr) and inorganic phosphate (Pi) were performed. The work loads in the present study were selected as mild exercise (1.63 W) and heavy exercise (4.90 W), corresponding to 18-23% and 54-70% of maximal exercise intensity. Long-distance runners showed a significantly smaller decrement in PCr and less acidification at a given exercise intensity compared to those shown by sedentary subjects. The transient responses of PCr and Pi during recovery were characterized by first-order kinetics. After exercise, the recovery rates of PCr and Pi were significantly faster in long-distance runners than in sedentary subjects (P < 0.05). Since it is postulated that PCr resynthesis is controlled by aerobic metabolism and mitochondrial creatine kinase, it is suggested that the faster PCr and Pi recovery rates and decreased acidification seen in long-distance runners during and after exercise might be attributed to their greater capacity for aerobic metabolism.

VO(2) kinetics in heavy exercise is not altered by prior exercise with a different muscle group.

We examined whether lactic acidemia-induced hyperemia at the onset of high-intensity leg exercise contributed to the speeding of pulmonary O(2) uptake (VO(2)) after prior heavy exercise of the same muscle group or a different muscle group (i.e., arm). Six healthy male subjects performed two protocols that consisted of two consecutive 6-min exercise bouts separated by a 6-min baseline at 0 W: 1) both bouts of heavy (work rate: 50% of lactate threshold to maximal VO(2)) leg cycling (L1-ex to L2-ex) and 2) heavy arm cranking followed by identical heavy leg cycling bout (A1-ex to A2-ex). Blood lactate concentrations before L1-ex, L2-ex, and A2-ex averaged 1.7 +/- 0.3, 5.6 +/- 0.9, and 6.7 +/- 1.4 meq/l, respectively. An "effective" time constant (tau) of VO(2) with the use of the monoexponential model in L2-ex (tau: 36.8 +/- 4.3 s) was significantly faster than that in L1-ex (tau: 52.3 +/- 8.2 s). Warm-up arm cranking did not facilitate the VO(2) kinetics for the following A2-ex [tau: 51.7 +/- 9.7 s]. The double-exponential model revealed no significant change of primary tau (phase II) VO(2) kinetics. Instead, the speeding seen in the effective tau during L2-ex was mainly due to a reduction of the VO(2) slow component. Near-infrared spectroscopy indicated that the degree of hyperemia in working leg muscles was significantly higher at the onset of L2-ex than A2-ex. In conclusion, facilitation of VO(2) kinetics during heavy exercise preceded by an intense warm-up exercise was caused principally by a reduction in the slow component, and it appears unlikely that this could be ascribed exclusively to systemic lactic acidosis.