Esophageal fibrovascular polyp removed by cervical esophagotomy

We report a case of esophageal fibrovascular polyp (FVP) removed by cervical esophagotomy. The patient was a 74-year-old man in whom an intraesophageal mass was detected by a chest CT examination during a complete medical check-up. An upper gastrointestinal series showed a large, pedunculated, cervical esophageal mass for which our preoperative diagnosis was a FVP. We studied its features, as well as removal procedures in 45 patients in the literature. Most patients had marked symptoms, but ours had no complaints, and so this case may be a rare one. Various removal procedures were reported, but thoracotomy and esophagectomy are considered to be the inappropriate procedures since FVP is a benign disorder.

Pharmacokinetics and pharmacodynamics of febuxostat (TMX-67), a non-purine selective inhibitor of xanthine oxidase/xanthine dehydrogenase (NPSIXO) in patients with gout and/or hyperuricemia

The diurnal change of sUA and the effect of febuxostat on this change were investigated in 10 patients with gout and/or hyperuricemia. The diurnal sUA change after the last dose during the 4-week treatment phase (20 mg, QD) was almost the same as the pre-treatment value. Considering the dose, the AUC(obs) and Cmax of unchanged drug in patients with gout and/or hyperuricemia were estimated to be similar to those of healthy male adults. The results show that a 6-week treatment with febuxostat is safe and well-tolerated in the target patient population for this drug.

Continuous wave Doppler echocardiographic evaluation of St. Jude prosthetic mitral valves in children

The function of 9 St. Jude prosthetic mitral valves in 8 children was evaluated by continuous wave Doppler (CWD) echocardiography 28 +/- 22 months after implantation. All valves were apparently functioning normally on clinical examination. Peak flow velocity, mean flow velocity, pressure half-time and mean pressure gradient were determined from the transmitral flow velocity curve by CWD echocardiography. For comparison, the same parameters were examined in 15 normal children and 14 adults who had undergone mitral valve replacement. All measured values were greater in adults and children who had undergone valve replacement than in normal children. There were no differences in any parameter in adults or children in whom prostheses 25 mm or larger had been implanted. Although 3 children in whom prostheses 23 mm or smaller had been implanted had greater values for each parameter than those who received 25 mm or larger prostheses, there were no symptoms or signs of mitral stenosis. These data may be useful as guidelines for normal Doppler characteristics for St. Jude mitral valves in children. In an asymptomatic child whose prosthetic valve developed obstruction by granulation tissue overgrowth, each parameter significantly worsened as the heart rate increased. The changes in these parameters in 2 normally functioning St. Jude valves during atrial pacing were insignificant. The fluctuation of Doppler characteristics with changes in heart rate is useful for differentiating normally functioning prosthetic valves from impending stenosis.

[Surgical treatment of cor triatriatum: report of four cases]

Four cases of cor triatriatum are reported. Cases 1 and 2 had IIA, case 3 had IA, and case 4 had IIIB 1 type of cor triatriatum according to Lucas-Schmidt classification. Cases 1 and 2 were diagnosed by echocardiography preoperatively. They were not performed cineangiocardiography because of pulmonary congestion. Case 3 had type IA so called classical type, which is hemodynamically identical to mitral stenosis and supravalvular stenosing ring. The clinical features are depend on the size of the communication between accessory chamber and true left atrium. As case 4, he had been diagnosed of simple atrial septal defect preoperatively, careful echocardiographic examination was essential for accurate diagnosis. In case 2 with hypoplastic left heart, secondary surgical repair is considered to be desirable followed by balloon dilatation of two atrial septal defects communicated to accessory chamber and to true left atrium. Thus, we expect development of hypoplastic left ventricle.

Gustatory signal processing in the glossopharyngeo-hypoglossal reflex arc of the frog

The relationship between the gustatory input and motor output in the glossopharyngeo-hypoglossal reflex was analyzed on the basis of neuronal activities in the solitary tract and hypoglossal motor nuclei of bullfrogs. Concentration-response relations for NaCl, quinine and acetic acid, obtained from the glossopharyngeal (IXth) nerve and simultaneously recorded from the hypoglossal (XIIth) nerve, were expressed relative to the response of each nerve to 1 M NaCl. Compared with a relatively small amount of the afferent input for acid, the reflex motor output was much larger in the relative value. A similarly high output relation was obtained for warmed saline but not for quinine and cooled saline. Although the responsiveness of the nucleus tractus solitarius neurons to 1 M NaCl and 1 mM quinine was not significantly different from that of the hypoglossal motoneurons, responses to 10 mM acetic acid were greater in the latter neurons than in the former by a factor of about 5.2. These phenomena were consistent with those in the peripheral nerves. The solitary tract neurons responsive to NaCl, quinine and acid showed both the phasic and tonic components of discharges. According to classification by a transiency index, the discharge mode became more phasic for the hypoglossal motoneurons responsive to NaCl and quinine, but more tonic for those responsive to acid. The above-mentioned chemoreflex is thus regulated by the intrinsic neural network which sends signals to the XIIth nerve after modifying not only the amount but also the temporal pattern of gustatory nerve signals for a particular taste.