[A case of recurrent liver tumor from gastric cancer responding remarkably to intra-hepato-arterial infusion of CDDP, MMC and Lipiodol].

A 67-year-old woman who received subtotal gastrectomy for advanced gastric cancer in 1985 was diagnosed as having a solitary liver tumor and increasing CA 19-9 for 2 years and 1 month after the operation. When an angiography was performed, we suspected a recurrent liver tumor from gastric cancer, and she received an intra-hepato-arterial infusion of 60 mg of CDDP, 8 mg of MMC and 5 micromilligrams of Lipiodol. The infusion was very effective, so 3 additional infusions were performed. There were no other recurrent lesions, so we performed tumor resection of the liver. Histologically, the resected tissue necrosed and no tumor cell was found. Therefore, it was difficult to diagnose whether the tumor was a recurrent liver tumor or hepatocellular carcinoma. From the clinical diagnosis and X ray findings, we suspected that it was the recurrent liver tumor. We report that this case responded to infusions and all tumor cells which necrosed were rare.

Relationships between the cryptic and temperate viruses of alfalfa, beet and white clover.

Small isometric virus particles containing double-stranded RNA have been independently reported in Europe and Japan from apparently healthy alfalfa (Medicago sativa), beet (Beta vulgaris), and white clover (Trifolium repens). They have been called cryptic viruses in Europe and temperate viruses in Japan. Serological comparison using immunoelectron microscopy, and polyacrylamide gel electrophoresis of the RNAs indicate that alfalfa cryptic and temperate viruses are the same, beet cryptic virus is probably a mixture of two different viruses, one of which is similar to or the same as beet temperate virus, and white clover temperate virus is a mixture of at least three different viruses, two of them indistinguishable from white clover cryptic viruses 1 and 2, respectively, and the third very likely the same as white clover cryptic virus 3.

[A case report of post-traumatic syringomyelia].

A case of posttraumatic syringomyelia which appeared 26 years after the injury was presented. A patient was 61 year old female, who sustained thoraco-lumbar spine injuries rendering her to paraplegic in 1954. Eleven months later she had an operation of T6-T9 and L1-L2 laminectomies and regained motor and sensory functions of the both lower extremities. She was ambulatory with crutches till 1979. In 1980, burning pain was noticed in the left scapular region, and thereafter, extended to the ulnar side of the left forearm. The pain became progressively worse and intractable. Analgesics were ineffective. Two years later muscle atrophies and weakness in the left finger intrinsic muscles appeared. Absent deep tendon reflexes in the left upper extremity, dissociated sensory loss (in the left C2-S1 and right T5-T12 dermatomes) and paraparesis were also documented. Metrizamide CT scan performed 24 hours after the intrathecal injection disclosed an intramedullary syrinx between C2 and L1 vertebral levels. No communication with the fourth ventricle was seen. A syringoperitoneal shunt with low pressure valve was placed. The pain subsided immediately after this procedure. However, no improvement in motor and sensory functions were observed. Pathophysiological mechanisms involved in post-traumatic syrinx formation and its development were discussed. We prefer hypothesis proposed by Ball and Dayan to Gardner's hydrodynamic theory regarding to development of the syrinx secondary to spinal cord injury.

Simultaneous surgery for Wolff-Parkinson-White syndrome combined with Ebstein's anomaly. Interruption of multiple accessory conduction pathways.

We detail the simultaneous surgical treatment of Ebstein's anomaly combined with Wolff-Parkinson-White syndrome in a patient who presented with multiple accessory conduction pathways. The extensively deformed tricuspid valve was replaced by a Hancock xenograft and the atrialized ventricle was plicated. Surgery was performed under the beating heart condition and this made possible electrical mapping which facilitated the localization of both accessory pathways. By the method presented here, all existing accessory pathways can be pinpointed during open heart surgery and the time of their interruption can be established. Two and a half years after surgery, chest X-ray revealed marked reduction of the cardiothoracic ratio and the patient experienced no postoperative tachycardia episodes.

Double pacemaker implantation.

A demand-type pacemaker and an inductive radiofrequency atrial pacemaker were implanted in four patients presenting with sick sinus syndrome, bradycardia-tachycardia syndrome, Wolff-Parkinson-White syndrome, atrial flutter, and paroxysmal atrial tachycardia, and in one patient having ventricular tachycardia with ectopic ventricular beats. Our follow-up of these patients showed that double implantation is feasible and effective in controlling different types of arrhythmia occurring in the same patient.

Hepatic blood flow measurement III. Total hepatic blood flow measured by ICG clearance and electromagnetic flowmeters in a canine septic shock model.

The validity of the ICG clearance method for the measurement of THBF in abnormal circulatory states remains questionable. In this study THBF measured by this method is compared with the electromagnetic flow technique in a canine spetic model. Good correlation is demonstrated between the two in normal control animals. However, in the septic animals the ICG underestimated the electromagnetic flow result by 20%. This is true in both the high and the low cardiac output septic shock pictures that emerge. In the septic animals, the total hepatic blood flow as measured by the ICG was almost equal to the portal vein flow alone measured by the electromagnetic flowmeters suggesting that this was the quantity it was measuring in this abnormal state. Pathophysiologic mechanisms that may explain the discrepancy are given.

Hepatic blood flow measurement.

Although many experimental studies have been made to determine the total hepatic blood flow in steady circulatory states, very few have been done in unsteady states of either circulatory overload or underload. In this experiment, a comparison is made between total hepatic blood flow measured by the single injection of indocyanine green and the electromagnetic flow methods in the dog, in which circulatory overload was induced by dextran 40 infusion. While there was close correlation between the values obtained by the two methods in normal dogs, following dextran infusion the indirect indocyanine green method overestimated hepatic blood flow by 40% to 60%, using the electromagnetic method as a comparison standard. The reason for this discrepancy is not elucidated by these studies.

Hepatic blood flow measurement. A comparison of the indocyanine green and electromagnetic techniques normal and abnormal flow states in the dog.

Very few studies have compared the total hepatic blood flow using the Indocyanine green (ICG) method with the instantaneous electromagnetic flow method under unsteady circulatory conditions. In this study, a hypotensive circulatory state was produced by rapid hemorrhage in 14 dogs. Total hepatic blood flow was measured using the ICG single injection method, comparing it with the electromagnetic flow method. After confirming the validity of the ICG single injection method in measuring total hepatic blood flow in the steady state, the experiment was then carried out using 23 normal healthy dogs. The close correlation between the ICG clearance technique and the electromagnetic values under normal steady state was confirmed. However, after hemorrhage the indirect ICG method estimated only 71% of the simultaneous electromagnetic flow value. It is reasonable to assume that while the electromagnetic method continues to measure the actual total hepatic blood flow in both the steady and unsteady states, the ICG clearance method measures only the functional hepatic blood flow which is reduced due to shunting or impaired hepatocellular function in the unsteady and hypotensive circulatory state.