A case of adrenal carcinoma with the tumor thrombus extending into the right atrium and right ventricle is reported. A 46-year-old man was admitted because of abdominal distention and back pain. Angiogram, venacavography, dynamic CT, cardio-echogram and determinations of blood concentration of hormones disclosed a huge non-functional right adrenal tumor and its thrombus having extended into the right atrium and ventricle via the right adrenal vein. Right adrenalectomy and nephrectomy were followed by simultaneous removal of the tumor thrombus. The resected tumor was 14 X 11 X 7 cm in size and 880 g. The thrombus was 90 g. Pathohistological diagnosis of sarcomatoid adrenocortical carcinoma was made. The patient was discharged three weeks after operation and had been remained asymptomatic for 5 months. He died of the recurrence of the tumor on the 206th postoperative day. In the review of English and Japanese literature, 61 cases of malignant tumors extending into the right atrium were analyzed, among which only one case was an adrenal tumor. From this survey, it seems that aggressive resection would provide better survival, and a surgical excision with a use of cardiopulmonary bypass is worth trying for such conditions.

Adrenal Cortex Neoplasms↗

PubMed1987

Mechanism of action of a novel antivasospasm drug, HA1077.

HA1077, but not the potent calcium entry blocker nicardipine reversed experimental chronic cerebral vasospasm induced in a two-hemorrhage canine model. The i.a. administration of HA1077 produced significant increases in vertebral blood flow in dogs. The effects of HA1077 on the vascular responses were studied in vitro. Spiral strips of rabbit aorta were mounted for isometric tension recording in physiological salt solution. HA1077 produced a competitive inhibition of the Ca++-induced contraction of the depolarized rabbit aorta. The pA2 of HA1077 for the Ca@-induced contraction was 6.71. The inhibitory effect of HA1077 on the KCl-induced contraction was not altered by atropine, propranolol, theophylline or indomethacin. HA1077 (10(-8) to 10(-4) M) inhibited contractile responses to KCl, phenylephrine (PHE) and prostaglandin (PG) F2 alpha similarly, whereas verapamil, diltiazem and nicardipine were much less effective in blocking the contractions induced by PHE or PG. Even in Ca++-free physiological salt solution, both PHE and PG were capable of contracting the aorta. These Ca++-free contractile responses to PHE and PG were antagonized effectively by HA1077. Verapamil failed to inhibit these contractions. We also investigated the effects of HA1077 on guinea pig heart contractility. In contrast to calcium entry blockers (which are known to have a direct negative inotropic effect), HA1077 did not change the developed tension in the left atrium at concentrations up to 3 X 10(-4) M. The present evidence demonstrates that the novel antivasospasm drug HA1077 is a class of calcium antagonists different from the calcium entry blockers.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗

PubMed1987

Left ventricular dysfunction and dilatation resulting from chronic supraventricular tachycardia.

It has been suggested that patients with chronic supraventricular tachycardia may have impaired ventricular function, which returns to normal after surgical procedures that eliminate the tachycardia. The purpose of this study was to determine the functional consequences of prolonged supraventricular tachycardia in 12 awake dogs in which permanent asynchronous atrial pacemakers were implanted and programmed to a rate of 190 +/- 5 beats/min. Serial radionuclide angiograms were obtained immediately after pacemaker activation and at regular intervals over a 3 month period. Chronic tachycardia resulted in a significantly depressed ejection fraction (49% +/- 1% to 29% +/- 3%; p less than 0.0005) compensated for by a dramatic increase in left ventricular end-diastolic volume (69 +/- 4 to 105 +/- 9 ml, p less than 0.005). Stroke volume and cardiac output were not significantly changed. Five dogs were allowed to recover, and serial radionuclide angiograms were obtained for 12 weeks. Although ejection fraction returned to control values (50% versus 47%, p = no significant difference), end-diastolic volume remained persistently elevated after a 12 week recovery period in all animals (67 +/- 5 versus 91 +/- 6 ml, p less than 0.05). Thus prolonged tachycardia resulted in significant functional changes associated with cardiac enlargement, which were not immediately reversible.

Animals↗

PubMed1987

[A case of Cushing's syndrome caused by an adrenal black adenoma].

A black adenoma of the adrenal cortex was surgically removed from an 18-year-old female who had clinical and laboratory findings characteristic of Cushing's syndrome. The electron microscopic study revealed typical features of steroid-producing cells, including a prominent smooth and rough endoplasmic reticulum, and mitochondria. In addition, many of the adenoma cells contained numerous pigmented granules which were lipofuscin. Three months after the surgery, the hormone levels returned to the normal range. The Japanese literature of functional black adenoma is reviewed.

Adenoma↗

PubMed1987

[A clinical study on head injuries in the aged].

We review 79 patients over 65 years old among 715 patients who underwent CT scans in the early period after head injuries, to study the characteristics of head injury in the aged. Among 79 aged patients, 24 developed posttraumatic subdural fluid collections, and in 13 of them chronic subdural hematomas developed subsequently. There were only three acute epidural hematomas. However, a high incidence of intracerebral lesions was noted, regardless of the presence of skull fracture. The pedestrian accident was the most frequent cause of head injury in the 36 aged patients admitted and the mortality rate of traffic accident in the aged was also highest. The relationship between Glasgow Coma Scale Score (GCS) on admission and the outcome was not parallel in the aged, because high GCS not rarely resulted in poor condition or death. Head injury is apt to occur and becomes severe in the aged pedestrian because of advancing carelessness and dull movements with age. The vulnerability of the brain to the injury and changes of intracranial environment in the aged tend to cause intracranial lesions much more than in the younger patients. Already-existing diseases and/or posttraumatic general complications also make clinical courses worse in the aged. It seems important for the improvement of the treatment that the characteristics described above are always taken into consideration throughout the period of the treatment in the aged, in order to eliminate worsening factors adequately. In addition, the social measures to cope with the suffering of the aged pedestrians from traffic accident should be considered and established in an aging society.

Accidents, Traffic↗

PubMed1987

[Clinical evaluation of pulsatile bypass with counterpulsation method in myocardial protection in infants].

Explore the source record for details and available documents.

Age Factors↗

PubMed1987

[Identification of HETE in the rat brain and its relevance to ischemic cerebral edema: Part 2].

We reported the detection of 11-hydroxy-eicosatetraenoic acid(HETE) in rat brain and its relevancy to ischemic brain edema. But the further study disclosed that the peak of 11-HETE on high performance liquid chromatography (HPLC) had been contaminated by dibutyl phthalate. The results and our speculation about the roles of 11-HETE in ischemic brain turned out to be incorrect. Re-examination of lipoxygenase products in rat brain was performed using gas chromatography-mass spectrometry (GC-MS) and HPLC. The rat middle cerebral artery (MCA) occlusion model was used. The rat was sacrificed by in situ freezing 24 and 72 hours after MCA occlusion. The identification and quantitative study of HETEs in normal and ischemic rat brain was performed by HPLC and GC-MS. In the present study, several kinds of HPLC were used to prevent misinterpretation by the contamination. Sham operated control rat brain contained only 15-HETE and its content was 2.1 +/- 2.1 (mean +/- SE) ng/g wet weight. In 24 hours ischemic brain, 11-HETE newly appeared and the 15-HETE content was increased. But these increases were not statistically significant. The hemisphere rendered ischemic for 72 hours contained all HETEs, namely, 5,9-, 8- and 12-, 11-, and 15-HETEs. Their amounts were 18.3 +/- 2.8, 16.6 +/- 3.0, 23.7 +/- 14.9, 14.0 +/- 3.4, 19.8 +/- 5.5 ng/g wet weight, respectively. All HETE contents except 8- and 12-HETEs were significantly increased 72 hours after MCA occlusion when ischemic cerebral edema reached its maximum (p less than 0.01, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1986

[Pseudo-Bartter's syndrome induced by surreptitious ingestion of furosemide to lose weight: a case report and possible pathophysiology].

Bartter's syndrome (B.S) is often difficult to distinguish from pseudo-Bartter's syndrome (pseudo-B.S), a condition which may be caused by "loop" diuretics abuse. Although our patient firmly denied ingestion of diuretics or laxatives, all screening of urine samples gave consistently positive results for furosemide, even during hospitalization. A 25-year-old married woman with persistent hypokalemia had many characteristics of B.S, including hypokalemic hypochloremic alkalosis, hyperactivity of the renin-angiotensin-aldosterone system, normotension, insensitivity to the pressor effect of angiotensin II (A.II), increased urinary excretion of prostaglandin E2 and kallikrein, and marked reduction of distal fractional reabsorption of chloride in Henle's loop, as estimated by CH2O/CH2O+C.Cl, under conditions of hypotonic saline diuresis. Furthermore, hypotension occurred with [1-Sar, 8-Ile] A.II and with the angiotensin converting enzyme inhibitor (Captopril). Renal biopsy revealed juxtaglomerular hyperplasia. A tentative diagnosis of B.S was made. Indomethacin (IDM), an inhibitor of prostaglandin synthesis was prescribed and the pressor response to A.II improved. Impaired fractional chloride reabsorption was also improved significantly under IDM, but the value was low compared to the normal. The value for basal plasma human atrial natriuretic polypeptide (hANP) was slightly above the normal ranges and was suppressed by IDM. We conclude that manifestations B.S in this patient may have been fostered significantly by the long-term surreptitious use of furosemide, taken to lose weight. The analysis of urine for detection of diuretics was only finding distinguishing her clinical state from "true" B.S and leading to a final diagnosis. Pathophysiologic relationships between B.S and pseudo-B.S due to furosemide are discussed.

Adult↗

PubMed1986

Interaction of GTP-binding proteins with calmodulin.

Two GTP-binding proteins (Gi and Go), which were the substrates for islet-activating protein, pertussis toxin, were purified from bovine cerebral cortical membranes. Both Gi and Go completely inhibited calmodulin-stimulated cyclic nucleotide phosphodiesterase activity. The same concentrations of these proteins, however, had no appreciable effect on the basal phosphodiesterase activity. The isolated Gi alpha and beta gamma subunits of GTP-binding proteins were potent inhibitors of the calmodulin-stimulated phosphodiesterase activity, but Go alpha was very weak. Therefore, the beta gamma subunits were likely to be the major active molecules in the brain membranes. GTP-binding proteins were shown to bind directly to calmodulin in a Ca2+-dependent manner by a gel permeation binding experiment.

2',3'-Cyclic-Nucleotide Phosphodiesterases↗

PubMed1986

Activation of the alternative pathway of complement by an antitumor (1----3)-beta-D-glucan from Alcaligenes faecalis var. myxogenes IFO 13140, and its lower molecular weight and carboxymethylated derivatives.

An antitumor (1----3)-beta-D-glucan with a number-average degree of polymerization (DP) of 540 from Alcaligenes faecalis var. myxogenes IFO 13140, and its lower molecular weight derivatives were found to activate the alternative pathway of complement (APC), as judged by hemolytic and immunoelectrophoretic analyses. Of the native and derivative (1----3)-beta-D-glucans measured, the smallest one that showed APC-activating ability was that with a DP of about 20. The effect of carboxymethylation of the (1----3)-beta-D-glucans with DPs of 49, 131 and 540 on their APC-activating ability was investigated. In any (1----3)-beta-D-glucan the ability was decreased with the increase of carboxymethyl substitution and was completely lost when about one carboxymethyl group per glucose residue was incorporated. In contrast, strong inhibitory ability against C1 hemolytic activity appeared on carboxymethylation.

Alcaligenes↗