Inferior vena cava occlusion catheter for pediatric patients with heart disease: for more detailed cardiovascular assessments.

Traditional evaluation of cardiac function is too often limited by reliance on measurements with complex interdependence between cardiac properties and loading factors. Analysis by ventricular pressure-volume (P-V), -area (P-A), or -dimension (P-D) relations during inferior vena caval (IVC) occlusion independently quantifies ventricular properties and loading conditions, providing detailed information about cardiovascular dynamics. However, there has been no appropriate size of balloon catheter that can effectively occlude IVC of pediatric patients, hindering the application of P-V (P-A, or P-D) analysis to children with heart disease despite its potential benefit. To address this problem, we have developed a new balloon catheter for IVC occlusion in children. The catheter effectively occluded IVC in 92 pediatric patients with varying forms of heart disease who underwent cardiac catheterization, yielding end-systolic pressure-area relations. Thus a newly developed balloon catheter would contribute to establishing more accurate and detailed cardiovascular assessments in children with heart disease. Cathet Cardiovasc Intervent 2001;53:392-396.

An evaluation of a new radiographic technique utilizing a concave table.

In conventional radiography systems, it is apparent that only the area immediately around the central x-ray beam can be evaluated accurately. Consequently in some instances, spinal radiography for example, several exposures are needed at various points along the body to create an accurate image for diagnosis. However, if the film and body part are in a concave shape such that the radius of the curve is equal to the film focal distance, the x-ray beam will penetrate the body and strike the film at two-dimensionally right angles in all areas. Using the spine as an example we found the curved technique had three major advantages over the traditional flat technique: lack of distortion, more uniform beam intensity due to a constant focal film distance, and improved resolution at the periphery of the radiograph because of lack of a cross over effect. It was concluded that an accurate evaluation of larger body parts can be made with minimal distortion utilizing the principles of a curved table technique.

[A study of the significance of serum beta 2-microglobulin levels in patients with multiple myeloma--analyzes as a marker of renal dysfunction and as a marker of tumor cell mass].

Renal involvement known as a myeloma kidney is often observed in patients with multiple myeloma (MM). This complication has been recognized as one of the most important prognostic factors in this disease. Serum beta 2-microglobulin (S beta 2-m) has been also recognized one of the prognostic factor that reflects both a glomerular infiltration rate and a volume of neoplastic cells, because beta 2-m usually can be produced by the neoplastic lymphoid cells. To clarify the significance of the S beta 2-m in MM, we compared S beta 2-m levels and the clinical stage, with another clinical parameters for renal function such as 24 hr creatinine clearance (24 hr Ccr), N-acetyl-beta-glucosaminidase (NAG) levels in urine and serum alpha 1-microglobulin (S alpha 1-m) levels. The elevated S beta 2-m levels were commonly observed not only in patients with stage IIIB, but also in stage IA, IIA and IIIA (76%) who have normal renal function judged by the serum nitrogen or creatine levels. S beta 2-m levels correlated with 24 hr Ccr the most, then correlated with S alpha 1-m levels and less correlated with NAG levels in urine. Although a single elevation of S beta 2-m levels with other normal findings of renal parameters was found only in three out of 30 MM patients, the S beta 2-m levels in these patients did not change after the chemotherapy which had led to the diminution of serum M-protein. Together with these results, it was suggested that the S beta 2-m levels mainly reflect the renal dysfunction even if it stays in the subclinical stage, and reflect less the number of neoplastic cells in MM patients.

[IgD-lambda type multiple myeloma associated with IgG-kappa type benign monoclonal gammopathy].

A 76-year-old man was admitted to Kisen hospital because of lumbago and chest pain. Laboratory examinations revealed a chronic renal failure with marked elevation of the serum BUN (48.8 mg/dl) and creatinine levels (8.2 mg/dl). The serum electrophoresis demonstrated a hypergammaglobulinemia with M peaks. An immunoelectrophoresis demonstrated monoclonal IgD-lambda and IgG-kappa proteins in the serum, and lambda-type Bence Jones protein in the urine (0.4 g/day). Bone marrow smears revealed an abnormal proliferation of atypical plasma cells (43%). A systemic X-ray examination of the skeletal system showed systemic osteoporosis without punched out lesion. The patient was diagnosed as having IgD-lambda type multiple myeloma and IgG-kappa type benign monoclonal gammopathy by quantifying concentration of two M proteins (1,160 mg/dl in IgD, 1,179 mg/dl in IgG, respectively). A combination chemotherapy with melphalan and prednisolone was administered monthly for multiple myeloma, and hemodialysis for the renal failure was performed 3 times a week. A marked improvement of his laboratory findings including a diminution of the serum IgD-lambda M-protein was obtained. On the other hand, IgG-kappa M-protein level was unchanged. Two M-protein levels showed a different behavior after the combination chemotherapy. Although the patient died of congestive heart failure, the partial remission of multiple myeloma has been maintained for 16 months with chemotherapy.

Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique.

BACKGROUND: Although cytologic examination of pure pancreatic juice obtained with a duodenofiberscope has been useful for the diagnosis of pancreatic carcinoma, the rate of false-negative results is reported to be high. To eliminate these false-negative results, the authors developed a new technique, endoscopic retrograde intraductal catheter aspiration cytology, especially for an accurate cytologic diagnosis of carcinoma of the body or tail of the pancreas. METHODS: The accuracy of conventional cytologic examination of pure pancreatic juice was assessed in 25 patients with pancreatic carcinoma, 29 patients with pancreatitis, and 52 control subjects. Pure pancreatic juice was collected from the pancreatic duct by endoscopic cannulation using a videoimaging duodenoscope after intravenous administration of secretin. The new endoscopic retrograde intraductal catheter aspiration technique was used in four patients with carcinoma of the body or tail of the pancreas and five patients with localized pancreatitis in whom a correct diagnosis was not made by previous cytologic examination of pure pancreatic juice. RESULTS: Positive cytologic findings were obtained in 76% of the patients with pancreatic carcinoma. Positive cytologic results were more frequent in patients with carcinoma of the head of the pancreas than in those with carcinoma of the body or tail. By the new technique, positive cytologic results were obtained in all of the patients with pancreatic carcinoma. This technique caused no severe complications. CONCLUSIONS: This procedure of endoscopic retrograde intraductal catheter aspiration cytology seems useful for diagnosis of pancreatic carcinoma.

Diagnosis of hepatic cavernous hemangioma by fine needle aspiration biopsy under ultrasonic guidance.

Percutaneous aspiration biopsy of the liver using a heparinized 22-gauge needle was performed under ultrasonic guidance in 11 patients with hepatic cavernous hemangioma. Ten (91%) of 11 biopsy specimens obtained were cytologically diagnostic for hemangioma. No indications of malignancy were found. There was no relation between the cytological diagnosis and the location, size, or ultrasonographic findings. No complications were encountered. These findings indicate that cytological examination of the liver by fine needle aspiration biopsy is useful in diagnosing hepatic cavernous hemangioma of any size and in any location, provided optimal route to the lesions is chosen.

The usefulness of saline-irrigated bile for the intraoperative cytologic diagnosis of tumors and tumorlike lesions of the gallbladder.

Intraoperative cytology was performed for 48 patients with polypoid lesions (36 benign and 12 malignant) of the gallbladder. The cytologic samples consisted of pure bile from 48 patients and diluted bile collected by saline irrigation from 29 patients. Pure bile gave 32 correct diagnoses (67%) and 14 diagnoses of inadequate material (29%), which contained few nondegenerated cells and made microscopic diagnosis unreliable. Inadequate material was frequently obtained in cases of cholesterol polyp (45%), tubular or papillary adenomatous carcinoma (50%) and polypoid carcinoma (17%), but not in cases of inflammatory polyp (0%). On the other hand, cytologic study of bile samples obtained by saline irrigation showed no inadequate material and only one false negative, from a case in which the cancerous focus was mostly covered with nonneoplastic epithelium. These results imply that saline irrigation succeeded in collecting many nondegenerated cells newly exfoliated from the wall of lesions and the technique is useful in the intraoperative cytologic study of polypoid gallbladder lesions.

Value of heparinized fine-needle aspiration biopsy in liver malignancy.

The accuracy of diagnosis of hepatic malignancy by percutaneous aspiration biopsy was compared using heparinized and nonheparinized 22-gauge needles. When a heparinized instrument was used, it was able to accurately diagnose malignancy and cytologic types of exfoliative cells. Heparinization also made it possible to recover small tissue fragments and make ultrathin sections for histologic examination. In this way, material suitable for cytologic and histologic examination was obtained from 100% and 95%, respectively, of 59 patients suspected of having hepatic malignancy. A correct diagnosis was made cytologically in 92.5% of patients with hepatic malignancy and in 89.5% of those from whom histologic material was obtained. From a combination of histologic and cytologic results, the overall diagnostic rate for hepatic malignancy was increased to 95%. This procedure proved to be a reliable method for diagnosis of hepatic malignancy.

Improvement of the preparation method for vaginal smears for the auto-cyto-screener.

An improved method of preparing vaginal smears for use in the Auto-Cyto-Screener is reported. The main alterations from the previous technique were the substitution of 2% formaldehyde phosphate buffer (pH 7.4) for 50% ethanol as the preservative fluid, the use of homogenization in place of sonication for cell aggregate dispersion and the introduction of Ficoll-gradient sedimentation, which not only removes leukocytes and other elements from the suspensions but also concentrates the cancer cells to some extent. An examination of cell deposition techniques showed that optimal results were achieved with the use of filter paper, not rubber, and with centrifugation performed immediately after loading the suspension into the chambers.