The present study was undertaken on 10 patients with angina undergoing percutaneous transluminal coronary angioplasty. The angioplasty procedure consisted of two successive 30-second balloon inflations at 5 minute intervals. After the first inflation, nicorandil (0.1 mg/kg) was given intravenously over a 2-minute period. The second inflation was then performed 3 minutes after the completion of drug administration. Myocardial ischemia was measured as the magnitude of ST-segment elevation on the intracoronary electrocardiogram (intracoronary ECG) recorded from the guidewire. Nicorandil significantly reduced the magnitude of ST-segment elevation. Nicorandil did not change the heart rate-blood pressure product, nor the oxygen saturation of the blood sampled from the great cardiac vein, nor the velocity of coronary blood flow in those patients with no evidence of collaterals. These results favor the conclusion that nicorandil prolongs the intrinsic ability of cardiac myocyte to withstand oxygen deprivation. This salutary effect is possibly due to a direct cellular mechanism because nicorandil did not modify the peripheral and coronary hemodynamic parameters that govern myocardial oxygen consumption.
A vesicoallantoic cyst in the umbilical cord was detected by fetal ultrasonography at 16 weeks of gestation. The blood flow through the umbilical vessels was evaluated with periodic color Doppler ultrasonographic examinations because compression by the cyst may cause reduction in blood flow and lead to fetal death. After disappearance of the cyst, the infant was delivered vaginally. Retrograde cystography revealed a narrow channel between the bladder and the navel, confirming patent urachus, which was resected without any complications.
Key wordsconstipation, intestinal neuronal dysplasia.Intestinal neuronal dysplasia was first reported by Meier-Ruge in 1971 1 . Similar cases have been mainly reported in Europe.Conversely, very few cases have yet to be reported in Japan. We present the case of a three-year-old Japanese boy with chronic and severe constipation. He underwent a modified Soave operation. The resected rectal mucosa showed typical findings of intestinal neuronal dysplasia, which included submucosal hyperganglionosis, giant ganglia, ectopic ganglion cells, and increased activity of acetylcholine-esterase in the lamina propria nerve fibers. 2 Pathological examination showed that the proximal end of the resected colon still had characteristics of dysplasia. Therefore, the dysplastic intestine was not completely resected. However, the constipation greatly improved and he is now followed on an outpatient basis. Case reportA 3 year-old boy presented to University of Tokyo Hospital with long-standing constipation since birth. Enemas were used, but were not very effective. His weight was 11.6 kg (-2 SD) and his height was 88.2 cm (-2 SD). Blood testing revealed moderate anemia (hemoglobin [Hb] 9.8 g/dL). We first examined his rectal contour with a barium enema. The change in rectal caliber that is typically visualized in Hirschsprung disease was not observed (Fig. 1). Anorectal manometry was performed and no relaxing reflex was detected in the anal sphincter with a rectal dilatation stimulus. A rectal mucosal biopsy was taken 2 cm from the anal verge and showed no evidence of ganglion cells. Hypertrophic nerve fiber bundles in the submucosal region were also noted. A specimen taken 3 cm from the anal verge showed submucosal giant ganglia and ectopic ganglion cells. From these pathological findings we concluded that the patient had a short segment of Hirschsprung disease with associated intestinal neuronal dysplasia. A rectal pull-through operation (modified Soave method) was performed with resection of the rectal internal sphincter that was 1.0 cm in width at its dorsal site. Rectal mucosal specimens taken at surgery demonstrated that the entire resected mucosa had submucosal ganglia (Meissner's plexus) and there was no aganglionic segment. We excluded Hirschsprung disease based on these findings. Conversely, the specimens had typical pathological characteristics compatible with intestinal neuronal dysplasia, which include the following (acetylcholine esterase activity was demonstrated by the modified method of Karnovsky and Roots; 3 iso-octamethyl pyrophosphoramide was replaced by diisopropyl fluorophosphate): hyperganglionosis of Meissner's plexus (Fig. 2a,b); giant ganglia in the submucosa (Fig. 2c,d); increased activity of acetylcholine esterase in lamina propria nerve fibers (Fig. 3a,b); and ectopic ganglia in the lamina propria (Fig. 3b,c). 2 Furthermore, in submucosal areas there was well-developed and abnormal vasculature that was surrounded by acetylcholine esterase-positive fibers (Fig. 3d,e). 2,4 All of these findings strongly sugg...
The typical symptoms of primary thyroid cancer are a cervical mass and cervical lymphadenopathy, while dyspnea, hoarseness, or dysphagia can occur in the presence of extrathyroidal involvement. Esophageal involvement or stenosis causing dysphagia without any influence on the trachea is rare because of the anatomical location of the esophagus and the trachea. We report herein a case of primary thyroid carcinoma advancing behind the esophagus with the trachea intact, which was difficult to diagnose by esophagoscopy or roentgenogram. Thus, thyroid tumors need to be differentiated from other possible causes of esophageal stenosis. Computed tomography, magnetic resonance imaging, and ultrasonography are useful diagnostic modalities to detect thyroid tumors causing esophageal stenosis.
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