Postprandial middle cerebral arterial vasoconstriction in cirrhotic patients. A placebo, controlled evaluation.

BACKGROUND/AIMS: The objective of this study was to determine whether cerebral arterial vasoconstriction occurs in relation to postprandial splanchnic blood pooling in cirrhotic patients. METHODS: The pulsatility and the resistive indexes and blood flow in the middle cerebral artery were measured by magnetic resonance imaging in 21 cirrhotics and 14 controls. These measurements were repeated 30 min after ingestion of a 400 kcal liquid meal or placebo. Seven controls and 14 patients received the meal, and seven controls and seven patients received placebo. RESULTS: In the fasting conditions, cirrhotics had a greater pulsatility index (0.81 +/- 0.10 vs. 0.67 +/- 0.05, P < 0.001) and a greater resistive index (0.61 +/- 0.04 vs. 0.53 +/- 0.04, P < 0.001) and a lower blood flow (127 +/- 42 ml/min vs. 167 +/- 37 ml/min, P < 0.03) in the middle cerebral artery compared with controls. Meal ingestion significantly increased the pulsatility index (P < 0.03) and the resistive index (P < 0.01) and decreased blood flow (P < 0.03) in the middle cerebral artery in cirrhotics but not in controls. In contrast, placebo ingestion had no effect on the hemodynamic parameters in the middle cerebral artery in the two groups. CONCLUSIONS: Results support the hypothesis that middle cerebral arterial vasoconstriction seen in cirrhotic patients is one of the cerebral artery's homeostatic responses to underfilling of the splanchnic arterial circulation.

Primary lipogranuloma of male genitalia.

Lipogranulomas developing secondarily in the genitourinary system have been reported rather frequently, but primary lipogranulomas without any past history of etiologically related conditions are rare. We report on 2 cases recently encountered in which tumors were diagnosed as sclerosing lipogranuloma on histopathologic examination.

The pathogenesis of experimental arteritis induced by Candida alkali-extract in mice.

The pathogenesis of experimental arteritis induced by Candida alkali-extract in mice was studied from the immunological, pharmacological and chemical points of view. The following results were obtained. 1) The incidence of arteritis increased in parallel with IgE antibody level of Candida, as shown by the PCA method. 2) Candida polysaccharide showed cardiotonic, coronary vasodilatatory and vasoconstrictive activities on Langendorff's and spiral preparation of rats. 3) Candida polysaccharide was shown to contain digitoxose by gas-mass spectrometry. From these results, it is suspected that this extract reacts on experimental animals by the toxic and immunological mechanisms, and that these mechanisms may be related to the occurrence of arteritis.

[An autopsy case of a so-called carcinosarcoma of the pancreas].

A case of a "so-called carcinosarcoma" of the pancreas that occurred in a 48-year-old female is reported. At autopsy, the pancreatic tumor was seen to have deeply invaded the gastric wall, causing ulceration. The pancreatic tumor consisted of two different histological components: a squamous cell carcinoma and spindle-cell sarcomatous tumor cells. Transitional areas between the two different tumor cells were also present. Since there were transitional areas and a lack of definitive electron microscopic evidence favoring a sarcoma in the sarcomatous tumor cells, the pancreatic tumor was considered to represent a "so-called carcinosarcoma".

[A case of metastatic carcinoma of the spermatic cord due to cholangioma].

Tumor in the spermatic cord is infrequent. Further, among such cases, it is extremely rare to encounter a carcinoma other than a nonepithelial malignant tumor; almost all are metastatic tumors. We recently experienced an interesting case of spermatic cord tumor in a 78-year-old male. He entered our hospital with the chief complaint of a right inguinal tumor. He underwent 2 operations to excise the tumor. The extirpated tumor mass from the right spermatic cord was composed of adenocarcinoma with abundant fibrous stroma, which is considered to be metastasis from the other viscerae. We were unable to find the primary focus in spite of extensive clinical and pathological examinations. In an autopsy about four months after the 2nd operation, the tumor was confirmed to be primary intrahepatic bile duct carcinoma, which is called cholangioma. There have been only 20 cases of metastatic spermatic cord tumor reported in Japan. However, we considered that this is the 1st case caused by cholangioma in Japan and even in other countries.

[A case of primary lipogranuloma of the spermatic cord].

A 54-year-old male who noticed a growing mass in his right inguinal region one month earlier visited our clinic with a pigeon-egg sized, hard elastic, and movable mass with an unsmoothed surface. The removed mass was 4 X 2 X 2.5 cm, weighed 11.5 g and its cut surface was greyish white. The histopathological diagnosis was primary lipogranuloma. Postoperative course was uneventful with no sign of recurrence one year later.

[Primary seminal vesicle carcinoma in a 19-year-old male].

A 19-year-old male with papillary adenocarcinoma of the seminal vesicle with cyst is reported. Cytological and histopathological studies were carried out and the relevant literature was perused. There are only 6 cases of carcinoma and 40 cases of cyst of the seminal vesicle in the Japanese literature. Moreover, ours is the first reported case of the co-existence of carcinoma and cyst in the seminal vesicle. There may be a pathogenetic relationship between the carcinoma and cyst in our case.

[Ossification arising in the atypical epithelium in primary stomach cancer--report of a case].

We report a case of primary stomach carcinoma arising in the atypical epithelium, which was accompanied with ossification. The patient was a 73-year-old man, who was operated because of the possibility of advanced Type IIa carcinoma. Grossly, a large papillary polypoid lesion was recognized in the anterior wall of the antrum near the pylorus ring. Histological study revealed well differentiated tubular adenocarcinoma arising in the atypical epithelium; ossification was found in the stroma without necrosis, calcification or chondrification. Ossification arising in primary stomach carcinoma is very rare. Only five cases of ossification in primary stomach carcinoma have been reported in the world literature; two of these were Japanese patients. Probably ours is the first reported case with both stomach carcinoma and ossification arising in the atypical epithelium.

[Two cases of renal arteriovenous fistula].

The first case was a congenital renal arteriovenous fistula in a 33-year-old woman and the second case was a secondary renal arteriovenous fistula in a 67-year-old man. Both cases were seen with asymptomatic gross hematuria without any cardiovascular symptoms. In case 1, the arterial stage of right selective renal angiogram demonstrated a cirsoid type arteriovenous fistula in the right kidney; then, partial nephrectomy was performed. Angiogram of case 2 demonstrated arteriovenous fistula in the lower part of the right kidney. In this case arterial embolization was performed. After reviewing the literature, we believe that partial nephrectomy or arterial embolization is the most useful operative procedure to treat almost all cases of the cirsoid type renal A-V malformation. Conservative treatment of arteriovenous fistula has increased during the post 10 years.

Estimation of subject-specific normal ranges based on some statistical models of an individual's physiological variations.

Three statistical models of the individual's physiological variations, proposed by Dr Eugene K. Harris, were applied to the long-term series of individual test results in our health control system. It was found from this study that, in most cases, the homeostatic model shows the best fit to the population level from comparing correlation coefficients between the observations and estimations made based on Harris's three models. It was also found that for most cases, the homeostatic model gives the most reliable estimates in individual's level from the comparison of the chi-square values between the observations and estimations made for the individual's successive test results. Further, for a group of members with hyperglycaemia, the proportion of individuals in whom the random-walk model produced the most accurate predictions was increased to the proportion in the normal group. In the age group under 39 years of age, the autoregressive model showed a relatively high degree of predictive success, while the homeostatic model showed a relatively low degree in comparison with the results found in other age groups. From these investigations, it was found that the physiologically normal state shows strict homeostatic stability.

Diffuse infantile fibromatosis.

A boy 15 months old with diffuse infantile fibromatosis in the thigh is reported. A rapidly growing tumor in the right thigh was the only clinical manifestation, suggesting a malignant soft tissue tumor. Macroscopically, the lesion in the medial vastus muscle with an illdefined border gave a pepper and salt appearance. Histologically, the lesion was characterized by an abnormal proliferation of fibroblasts accompanied by some fibrosis, infiltration of chronic inflammatory cells, formation of lymphoid follicles, proliferation of capillaries and the presence of a small number of mature fat cells. No evidence of recurrence is found at present one and half years after operation.