IMPROVED BALLOON‐TIPPED TRANS‐ANAL ILEUS TUBE

Background: For management of bowel obstruction due to colorectal cancer, endoscopic trans‐anal decompression technique has been first reported by Lelcuk et al. in 1986 using balloon dilatation technique. Since then, various types of trans‐anal decompression tubes have been clinically used for patients suffering from left side obstructing colorectal cancer as an emergent decompressing device. At present, two types of trans‐anal ileus tube (trans‐anal decompression tube) have been available for clinical use, but they have two main problems that are late colon perforations caused by the tip of the tube and tube obstruction by stool. Methods: Analysis on three late colon perforations experienced with the use of conventional devices drew possible improvements to make a trans‐anal ileus tube less harmful. To overcome the pitfalls inherent to conventional tubes, the author has developed an improved trans‐anal ileus tube with a balloon installed at the very end of the tube (‘balloon‐tipped type’) made of silicone, measuring 1200 or 1700 mm in total length and 22 Fr in outer diameter. It has been used for 12 cases with obstructing colorectal cancer etc. and its outcomes were compared with those obtained by the use of conventional trans‐anal ileus tube. Results: No late perforations have been encountered, but tube obstruction did occur in one of 12 cases. Conclusion: The new trans‐anal ileus tube with a balloon installed at the tip of ileus tube is considered to be safer and especially effective in preventing late colon perforation and tube obstruction.     

Renovascular hypertension: a unique cause of unilateral focal segmental glomerulosclerosis.

A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.     

Long-term follow-up (20 to 25 years) of tetralogy of Fallot after correction

Eighty patients with tetralogy of Fallot who underwent corrective surgery between 1965 and 1970 were followed and evaluated. Late death was observed in 8 patients, and 3 of them were cardiac deaths. The survival rate at 10-year was 96.2%, at 20-year was 91.7%, and at 24-year was 89.0%. Of the surviving patients, 78% to 85% are spending normal social life. Twenty female patients experienced 31 deliveries, and no babies with cardiac anomaly were born. Most of the complaints come from late arrhythmias, and this is the main problem in the long-term period. Right ventricular function is considered to be moderately reduced by catheter analysis. The importance of preservation of right ventricular function during the surgery should be stressed.     

Arpp,a new homolog of carp,is preferentially expressed in type 1 skeletal muscle fibers and is markedly induced by denervation

In this study, we isolated and characterized a murine counterpart of the human Arpp (hArpp) gene. Sequence analysis revealed that the murine Arpp (mArpp) gene is almost identical to the Ankrd2 gene, which has recently been isolated as a mouse gene induced in stretched skeletal muscle. The mArpp gene encodes a protein of 332 amino acids that contains four well-conserved ankyrin-repeat domains in the central portion of the protein. The amino acid sequence of mArpp protein (mArpp) is highly homologous to that of mouse cardiac-restricted ankyrin-repeat protein (Carp), which is proposed to be a putative genetic marker for cardiac hypertrophy. Immunohistochemical analysis revealed that mArpp is preferentially expressed in type 1 skeletal muscle fibers, and that mArpp is localized in both the nucleus and the sarcomeric I-band of muscle fibers, suggesting that Arpp may function as a nuclear and sarcomeric protein. Furthermore, mArpp was also expressed in neurons of the cerebellum and cerebrum, the islets of Langerhans in the pancreas, and the esophageal epithelium, suggesting that mArpp may play a functional physiologic role in brain, pancreas, and esophagus as well as in type 1 muscle fibers. Interestingly, although mArpp was localized in both nucleus and cytoplasm in neurons, its localization was restricted to nucleus in pancreas and esophagus, suggesting that intracellular localization of mArpp is regulated in a tissue-specific manner. Furthermore, we found that mArpp- and Carp-expression in skeletal muscle were markedly up-regulated after denervation. Although the elevated expression level of Carp was kept only for two weeks after denervation, that of Arpp was kept at least for 4 weeks, suggesting that mArpp and Carp may play distinct functional roles in denervated skeletal muscle.     

Aplastic anemia: lack of increase of in vitro colony formation after T cell depletion with monoclonal antibodies and complement

To detect suppressor T cells to hematopoietic stem cells, growth of granulocyte-macrophage colony-forming cells (CFU-GM) and burst-forming unit (BFU-E) was compared before and after treatment of bone marrow cells with anti-T monoclonal antibodies and complement in 29 patients with aplastic anemia. The anti-T monoclonal antibodies used were 35.1 (CD2), Tp120 (CD6) and ATL27 (not clustered). Treatment of normal bone marrow with anti-T monoclonal antibodies and complement resulted in complete (greater than 99%) lysis of T cells with negligible effects on colony growth. Preincubation of marrow samples with monoclonal antibodies and complement did not enhance CFU-GM or BFU-E colony growth in patients with aplastic anemia. Using this assay, there was no evidence of T cell-mediated inhibition of colony proliferation in any of 29 patients.     

β-Adrenergic modulation of prepulse facilitation of L-type calcium channels in rabbit ventricular myocytes

It is reported that strong depolarization augments cardiac L-type Ca currents by inducing the special gating mode with long-lasting openings (mode 2) (Pietrobon and Hess Nature 346:651-655, 1990). However, a prepulse to +90 mV did not obviously facilitate the current at 0 mV in rabbit ventricular myocytes as measured in the whole-cell configuration of the patch-clamp method in the presence of 2 mM BaCl(2) in the external solution. In the presence of isoproterenol (1 microM), the inactivation during the prepulse was attenuated, and the prepulse evoked facilitation. However, the current at 0 mV whose amplitude was normalized to the extent of the inactivation at +90 mV still exhibited greater facilitation in the presence than in the absence of isoproterenol. In the cell-attached configuration with 110 mM BaCl(2) in pipettes, repolarization from +110 to +20 mV yielded mainly blank sweeps (mode 0) and only occasionally mode 2, leading to no facilitation of the average current. Isoproterenol augmented the prepulse-induced increase in mode 2, reciprocally inhibited that in mode 0, and increased the fraction of mode 2 in non-blank sweeps after the prepulse. Therefore, beta-adrenergic stimulation favors mode 2 rather than mode 0 at strongly depolarized potentials, thereby promoting the prepulse facilitation and attenuating the inactivation of cardiac L-type Ca currents.     

Ventilatory response to hypercapnia in sprint and long-distance swimmers

Summary Ventilatory response lines to carbon dioxide at rest were determined by the rebreathing method in 10 untrained subjects, 17 sprint swimmers, and 11 long-distance swimmers. It was found that the mean slope of the ventilatory response line of the swimmer was lower than that of the untrained group, and the mean slope of the long distance swimmer was lower as compared with the sprint swimmer, though these differences were statistically not significant. The differences in the hypercapnic drive between untrained subjects and swimmers obtained here is discussed in connection with their maximum oxygen uptake.     

Effects of acute hypoxia on ventilatory response at the onset of submaximal exercise

In order to investigate the effects of acute hypoxia and accompanying hypocapnia on the ventilatory response at the onset of dynamic exercise, four healthy adult men performed 50W rectangular loads on a cycle-ergometer in normoxic (FIO2 = 0.21) and hypoxic (FIO2 = 0.11) conditions. No statistically significant differences in the initial ventilatory responses to exercise (both delta VI and delta VE assessed on a breath-by-breath basis) were found between eucapnic normoxia (PETO2 approximately 95, PETCO2 approximately 42 Torr) and hypocapnic hypoxia (PETO2 approximately 45, PETCO2 approximately 35 Torr). The present findings support the contention that the neurogenic ventilatory drive at the onset of early exercise is independent from PO2 and PCO2.     

Successful treatment of acute renal failure in a patient with essential mixed cryoglobulinemia using prednisolone and cryofiltration

We report a case of acute renal failure associated with cryoglobulinemic glomerulonephritis. The patient, a 49-year-old woman, was referred to our hospital because of acute nephritic syndrome. After admission, she developed oliguria, and hemodialysis was instituted. Renal biopsy was performed and the specimens showed moderate endocapillary proliferation, large deposits filling the capillary lumen ("intraluminal thrombi"), and a double-contoured appearance, which are typical morphologic features of cryoglobulinemic glomerulonephritis. Immunoelectrophoresis showed a monoclonal increase of IgM kappa. On the basis of these findings, we diagnosed type II essential mixed cryoglobulinemia. Cryofiltration was performed with oral administration of prednisolone. Following the start of therapy, the patient's renal function gradually improved. Because of severe hypoproteinemia, cryofiltration was discontinued after three sessions. However, renal function recovered and was maintained with prednisolone only. This case shows that acute oliguric renal failure caused by cryoglobulinemic glomerulonephritis can be reversible if immunosuppressive therapy, together with plasmapheresis in more severe cases, is instituted promptly.