[Transient left ventricular dysfunction is still present one hour after exercise stress test: evaluation by gated SPECT with 99mTc-labeled perfusion agent].

It has been reported that quantitative gated SPECT (QGS) has revealed post-stress dysfunction of the left ventricle (LV) 30 minutes after a stress test. The purpose of this study was to determine whether post-stress dysfunction of LV is still present one hour after an exercise stress test. The subjects comprised 152 patients (124 males and 28 females, mean age 59 +/- 10 years). Exercise stress myocardial scintigraphy was performed using a one-day, stress and rest protocol. 99mTc labeled myocardial perfusion tracer, tetrofosmin, 370 MBq was injected at the end-point of a supine ergometer stress test for stress imaging. ECG gated SPECT was carried out 1 hour after injection. Three hours later, 740 MBq to 1100 MBq of 99mTc labeled myocardial perfusion tracer was injected for rest imaging. ECG gated SPECT was again performed 1 hour after injection. We divided the subjects into four groups according to the severity score of defects on the stress image and the presence or absence of fill-in; normal (NOR, n = 59), myocardial infarct (MI, n = 65), small ischemia (S-IS, n = 13) and large ischemia (L-IS, n = 15). Post-stress dysfunction is defined according to two criteria: 1) rest LVEF--post-stress LVEF > or = 5% and 2) post-stress ESV--rest ESV > or = 5 ml. The frequency of post-stress dysfunction was 3.4%, 9.1%, 23.1% and 40% in NOR, MI, S-IS and L-IS, respectively. Post-stress LV dysfunction was found to be more frequent in the large ischemia group. In conclusion, post-stress dysfunction was present 1 hour after the stress test and was more frequent in the large ischemia group.

[Nonobstructive urinary tract dilatation due to diabetes insipidus in a patient with craniopharyngioma].

A 46-year-old man who had a history of hypogonadism, bilateral hydronephrosis and huge residual urine volume during the past ten years was admitted complaining of fever and flank pain. Polyuria which was more than 4 liters per day and inability of urine concentration suggested diabetes insipidus. Magnetic resonance imaging (MRI) demonstrated a tumor which was compatible with craniopharyngioma. Tumor resection and administration of desmopressin improved polyuria and urinary tract dilatation with marked reduction of residual urine volume from 400 ml to 20 ml.

Hepatic gastrinoma.

A solitary hepatic tumor in a 50-year-old woman, which was observed as a hemangioma, ultimately was resected because it increased in size. The tumor volume doubling time was 28.8 months over the observed period of 30 months. The histologic diagnosis was carcinoid tumor. Immunohistochemical staining showed strong focal reactivity for gastrin and diffuse reactivity for pancreatic polypeptide, vasointestinal polypeptide, calcitonin, and parathormone. Preoperative gastric hyperacidity with diarrhea and a body weight loss of 7 kg, moderately controlled by cimetidine on admission, suggested high serum gastrin levels produced by the tumor. Her symptoms resolved after surgery, and she had a normal serum gastrin level with negative secretin stimulation test results. A review of six cases of hepatic gastrinoma suggests that surgical resection, if feasible, would be the treatment of choice.

[A blind point of vent catheter: air aspiration].

We experienced a case of saphenous vein air embolism after coronary artery bypass graft, in which case we used vent catheter kept in the left atrium. Though it was considered that air bubbles were never aspirated through vent catheter, we speculated that the origin of air bubbles must be the vent catheter. And we made an experiment on the motion of air in the vent catheter using a model of left heart composed with soft reserver (atrium) and pulsatile pump (ventricle). When the pulsatile pump was arrest, the air bubbles were never aspirated from the vent catheter to the soft reserver even if we vented with strong negative pressure. But, when the pulsatile pump was in motion and the left atrium was vented with some negative pressure, some leaks of air bubbles were recognized. So we must pay much more attention to the degree of venting when the heart is in motion. Sometimes we use overpressure safety valve composed with vent catheter, but measured left atrial pressure showed that decreased left atrial pressure was only 2 mmHg. So its use should be restricted in the patients with good ventricular function.

[Secondary tricuspid insufficiency and right atrial myosin ATPase activity].

Myosin of heart muscle shows ATPase activity. In the atrial myocardium, normal isozymic pattern was alpha dominant which converted to being beta dominant in an overloaded hypertrophy. In order to clarify the distribution of myosin isozymes in human heart, ATPase activity of the atrial myosin recovered from the patient underwent open heart surgery was determined. In the present study, ATPase activity of right atrial myosin from the heart with tricuspid regurgitation (TR) (group A (n = 6); 398.1 +/- 67.0 nmol pi/mg/min) was significantly less than that from the heart without TR (group B (N = 7); 533.9 +/- 62.4, p less than 0.05). The myosin ATPase activity showed correlation with systemic RA pressure (y = 0.019x + 19.6, r = -0.68429), systemic RV pressure (y = 0.039x + 58.67, r = 0.73484), SVI (y = 0.05x + 18.1, r = 0.87587) and RV maxDp/Dt (y = 0.42x + 589.9, r = -0.67493) (p less than 0.05). These data suggests that preoperative cardiac function involves in cardiomuscular structure with redistribution of contractile protein.

[A glomus tumor of the stomach associated with a lipoma].

A case of Glomus tumor of the stomach associated with a lipoma in a 65-year-old female is reported. The patient complained of epigastralgia for three months prior to her admission. X-rays, as well as gastroscopic examinations, revealed two submucosal tumors, one located along the greater curvature of the gastric antrum and the other on the posterior wall of the upper corpus. A preoperative angiographic study showed hypervascularity and tumor staining. Histologically, one tumor was diagnosed as being Glomus tumor and the other, a lipoma. Thus this rare case of two submucosal tumors in the stomach is discussed and 39 previous gastric Glomus tumor cases found in the domestic literature are reviewed.